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 authors illustrate an original method of osteosynthesis concerning shaft fractures in children: Stable Elastic Nailing. They elaborate the physiopathological basis and specify all details of this technique. The results of this treatment as well as its limits are considered through personal experience of 217 femurs, 42 tibias, 36 humerus, 84 fore-arms and 96 supracondylar fractures of the humerus. We essentially proceeded for a comparative analysis with other methods of osteosynthesis or conservative treatment, illustrating the net superiority of stable elastic nailing in their indications according to the recommended technique.

33 children with displaced SFH were all treated operatively by open reduction and internal fixation or closed reduction and percutaneous pinning. A follow-up study was performed on average 29 (range 3-63) months after the injury. In 18% of the cases an initial injury of the neurovascular structures was observed and documented during the operation. 32 times open reduction and internal fixation by K-wires was performed, only once, closed reduction and percutaneous pinning was attempted. In the presence of a preoperative neurologic deficit, the nerves were always visualised, never, however, a nerve suture was necessary. In one case we had to reconstruct both the arteria brachialis and radialis because of intima lesions with total obstruction of the vessels. The average time of hospitalization was 9 days, which includes the time for removal of the pins, which was usually performed about 4,5 weeks later simultaneously with the removal of plaster. Using Innocenti's criteria, 27 of 30 reviewed patients had an excellent result, 3 had a good result. Early complications due to the operation such as wound healing problems, infection or nerve lesions did not occur. 3 patients could not be reached any more. We recommend for the management of the displaced SFH open reduction and internal fixation by K-wires as the method of choice. Percutaneous pinning is a valid alternative when closed reduction succeeds easily at the first attempt.

Malunited fractures of the distal end of the radius are corrected by an osteotomy transversely oriented at the level of the angulation (15 cases reported). After correction of the deformation (length and angulation) compact iliac bone graft is inserted. 5 malunited fractures with a volar deformation were corrected by a palmar surgical approach and AO-T-plate fixation. 8 cases with a dorsal displacement were corrected by a dorso-lateral surgical approach and fixed with K-wires (7 cases) and without any internal fixation (1 case). 2 cases with dorsal displacement were corrected by a palmar approach and AO-plate fixation. Clinical and radiological results are good, except one case with secondary displacement and malunion which needed an ulnar head resection and the other, in which the radius was not enough lengthened, and needed the ulnar to be shortened.

The authors underline the importance of the precocious surgical treatment of the complex lesions of the carpal bones, especially in case of concomitant neurological lesions. The quality of the late results depends on the careful anatomical reconstruction and on the fixation during a suitable period with the aim to obtain a satisfactory repair of the carpal ligaments.

68 patients have been treated by regional intravenous blocks with guanethidine. 251 blocks have been realized. The majority of the patients received 3 blocks of one week. Some of them got a second series of 3 blocks after a minimum interval of one month. The study included 3 groups of patients. The first group showed 12 patients in the first stage of Sudeck; the second group 22 patients in the second stage. The third group included 34 patients for which the indication to blockade had been a chronic painful stage (19 cases), an ankylosis (8 cases), a Dupuytren post-traumatic contracture (3 cases) a stage before the operation predisposing to dystrophy reflex (3 cases) and one case of hyperhidrosis of the hand. Considering the three groups it can be stated that the first one responded the best to the treatment with a success in 80% of the cases. This success confirms the necessity of intervening as soon as possible in case of an algoneurodystrophy. The third group reveals that this therapeutical method can be useful in other situations than the dystrophy reflexes. The indication herewith is more founded on a possible sympathetic origin of the troubles as on the comportment psycho-affective of the patient.

The Swiss workers' compensation law prescribes experience rating. Successful efforts of an employer to reduce the risk of accidents through adequate preventive measures on one hand, and on the other hand to keep subsequent costs of still occurring accidents low with quick, consistent and generous measures of rehabilitation, will therefore result in a lower insurance rate. The motivating influence and success of this self-responsibility is pointed out with the figures of a trading company who had been detached from a large risk-community due to bad results. The success with accident prevention and the very favourable ratio achievable of costs for medical treatment (as a measure for the severity of the injuries) to daily payments and costs for permanent disabilities is shown with the example of a construction machinery company. What relations and consecutive costs result from (partly conscious) neglect of rehabilitation is demonstrated with the figures of a construction company.

The first carpal row acts as an important functional unit. The position of the lunate and scaphoid and their relationship within the wrist are wellknown. On the lateral radiography they are easily recognized so that one is able to define and measure accurately their relative position. The position of the triquetrum and its relationship to the adjacent bones have not been previously very well defined. However, it is possible to consistently identify the axis of the pisotriquetral joint on the lateral radiography. From this line the position of the triquetrum can be inferred. We measured the axis of the pisotriquetral joint in a random sample of 102 cases (40 men and 62 women), and compared it to the axis of the radius. Thus, using the pisiform axis as a marker, the position of the triquetrum can be accurately defined. Its movement correlates well with that of the adjacent bones.

Shaft fractures in young children have certain characteristics that are related to the type of accident and bony structure of this age group, the rapid healing process, and the long subsequent growth period. 1. Due to the high incidence of falls, green-stick, compression, and torsion fractures predominate. 2. Reduction and immobilization can nearly always be achieved by conservative treatment or simple osteosynthetic procedures. 3. The intensive remodelling process makes precise reduction unnecessary. Tolerance is greatest for side-to-side displacement and least for rotational deformities, especially in the forearm and leg. 4. The most common consequence of fracture healing is overgrowth of the fractured extremity, the intensity of which increases in proportion to the degree of spacing in the fracture area. 5. Complications are uncommon and are due mainly to overlooked rotational deformities, repeated manipulations, erroneous indications, or inappropriate internal fixation. 6. Anticipation of further growth is never an acceptable excuse for leaving an improperly aligned fracture to be "outgrown". 7. When certain basic precepts peculiar to this age group are observed, the treatment of shaft fractures in young children nevertheless carries a favorable prognosis.

In the paper we present the result of an epidemiological study we conducted upon injuries due to road accidents in Canton Ticino. We reviewed 1471 injured patients during two periods: in 1982 we examined all patients evaluated in the Emergency Room and admitted - if required - in all the Canton Ticino Hospitals. In 1985 we reviewed only patients seen at Ospedale Civico Lugano and patients seen by the police department (SIR) because the lesions were life-threatening. 106 (8%) patients died, 206 (15%) were seriously injured (87 patients with chronic infirmity) and 1062 had slight injuries. The total lesions were 2900 and 839 surgical operations were necessary. These patients needed a 7804 days of hospitalization (677 days in the intensive care unit). Motorcycles represented 46.5% of the involved vehicles. The major risk groups by age are: 14-17 years old (motorcyclist), 18-29 years old (automobilists and motorcyclists), up to 13 and over 60 years of age (pedestrians). The percentage of the total road accidents which occur at the week-end is of 49.4%. At rush/hours (5.00 pm) the percentage of accident is 8.1% (115 accidents) and in the early morning hours the percentage is 5.5% (74 accidents). The annual hospitalization costs amounted to 3,200,000 sFr., whereas the real costs corresponding to production loss, social expenditures (25.737 were the days of disability) and in- and out patient care are as high as 100 million francs.