Magyar traumatologia, ortopedia, kezsebeszet, plasztikai sebeszet最新文献

Authors describe a case of severe hand injury, caused by a funnel producing equipment. In the region between the metacarpals II and III a high pressure, penetrating, mechanical and thermal injury has arisen. The secondary necrosis expanded and this made a covering with soft tissue of full value necessary. Because of the local relations and allergic complications the local and distant possibilities were narrowed. It was possible to find a final solution by the transfer of flaps from the index and III finger and supplementary plastics, using split thickness skin grafts. The result was functionally perfect, esthetically adequate.

In the Department of Traumatology of the County Hospital "Kaposi Mór" 150 children with supracondylar fracture of humerus were treated during 10 years (1980-1989). 119 cases reduced and pinned with percutaneous Kirschner wire are dealt with. 98 cases could be controlled 2-10 years after the accident. The importance of urgent treatment is stressed. The urgent reduction and the closed pinning with Kirschner wire are thought to be an efficient prophylaxis against Volkmann's ischaemic contracture and varus deformity, caused by secondary movements.

Authors report on the results of Rocephin prophylaxis in 30 total prostheses. The dose of the preparation was 2g/day. It was given 3 times in intravenous drop infusion 1-1.5 hours before the operation and on the second and third day. The drains were then removed. During 1 year observation no wound infection was observed. As a postoperative complication exacerbation of chronic bronchitis, existing already since years, was found. This however healed after 5 and 6 days of Rocephin and expectorant treatment. As side effect of the medicament, in single cases, vomiting, stomatitis, thrombocytopenia and allergic dermatitis were observed. It is stated, based on own experience, that the broad spectrum Rocephin, belonging to the third generation cephalosporins, securing a 24 hours bactericide activity, is suitable in a single 2g dose/day in hip endoprosthesis to prevent postoperative infections.

Authors report on the long time (in average 12 years, range: 5-36 years) follow-up results of 5 cases of adamantinoma, localized on the tibia. In one case recurrence was found very late, 20 and 36 years after the primary wide resection, and resection was repeatedly performed. Because of problems of differential diagnosis in one case the tumor was excised intralesionally (curettage + plasty with cancellous bone). 7 years later the persistence of the process was found only. 1 patient died in consequence of pulmonary metastasis 9 years after the primary operation. Wide resection is suggested both for the removal of the primary tumor and the recurrences, appearing very late. For the reconstruction of the bone autologous fibula is proposed. Adamantinoma is thought to be a low malignity tumor, the outcome of which cannot be predicted from the clinical and histological findings. Considering the late recurrences and metastasis a long range, minimally 10 years, following of the patient is thought to be necessary.

Authors report on their experiences with autologous transfusion. Autotransfusion was used in THP in 234 cases with previous taking off. A comparative analysis is given with the homologous transfusions in THP in the same period. On the basis of their experiences this method is offered to the orthopaedic departments.

Authors describe an extremely rare case of simultaneous bilateral posterior dislocation of the shoulder. The referring international literature and that of this country is surveyed. In the latter no paper, describing bilateral posterior dislocation of the shoulder was published. They have found this case, because of its rarity, worthy of publication.

The classical autologous bone transplantation is introduced by the author. Summary is given on the advantages, disadvantages of this method and on the personal experience. The personal experience based on 55 cases from 49 patients. Concerning the clinical result, 3.5 months average healing time was observed, followed by autologous bone transplantation. The final outcome was not affected by the amount of transplanted bone. The message of this publication is to introduce the disadvantages and the limitation of using this classical method. The most frequent complication was the donor site pain. The publication is summarizing the advantages and the disadvantages of this method in Hungary for the first time.

The aim of these in vitro series of experiments was to state whether the medicaments used in the treatment of loss of bone density the Calcitonin, NaF and Ipriflavon do have a direct effect on the preosteoblast cells. The results show that both the Calcitonin and Fluorid stimulated the development of the fibroblast colonies and the NaF had a role in the increase of the alkaline phosphatase too. In the concentration of Ipriflavon applied no effect could be demonstrated in any parameter.

The results of 3 bone biopsies in patients with Sillence I. type of osteogenesis imperfecta are described. The biopsy material was examined with light microscope histomorphometric and various electron microscopic methods. Histomorphometry showed that the osteoid rim (OS%) and the steroid surface covered by osteoblasts (OB%) was significantly greater, in the same time the relative quantity of osteoid (Vvos%) was significantly less, compared with the normal bone. Electron microscopy showed the broadening and unevenness of the mineralization front. The diameters of the collagen fibers were quite unstable compared with the control. The structure of the newly developed apatit crystals was not different, although their measure was less than of the control. The microanalytical examinations of Ca/P relation of the crystal phase did not show any difference.

Author reports on the experiences with the operative treatment of 48 acetabular fractures in his Department during 19 years. He thinks that the operative treatment of the acetabular fractures may be successful only after the exact preoperative diagnosis and classification of the type of the fracture. After this the exposure may be chosen. During the operation one has to strive to the exact reconstruction of the articular surfaces and the performance of such stable osteosynthesis that will enable the early movements of the joint without weight bearing. If, because of the severity of the injury, the exact reconstruction of the acetabulum is not possible an effort must be made to create an anatomical situation that will give favourable conditions to late reconstruction operations (arthrodesis or endoprosthesis). Author describes after discussing the classification, diagnosis and treatment of the acetabular fractures his own results: in more than 3/4 of his cases excellent or good late results could be achieved. For this, with correct indication, the performance of the reconstruction operation is suggested.