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

Authors discuss, based on the experiences of their 18 cases, the injuries of the knee extensors. 5 ruptures of the quadriceps and 9 of the lig. patellae propr. were observed in the 14 cases controlled. Based on their own experiences and the standpoints of the literature they suggest the operative therapy within 6 hours in the open injury and within 1-5 days following the accident in closed cases. The experiences, the operative technique, the viewponts of the aftercare and the end results are described.

Authors describe the diagnostic and therapeutic problems of the traumatic dislocation of the hip in children and report on the experiences of their 8 cases. It is stressed that the condition of the good result in the early diagnosis and reduction. For the recognition and treatment of the late complications a 1.5-2 years follow-up of the patients is thought to be important.

Authors report on experiences gained with the Total Condylar knee prosthesis, representing the third generation in the development of the knee endoprosthesis. Based on results of 17 operations it is stressed that after the implantation in the severely degenerated or destroyed knee joint they succeeded to reach a significant decrease of pain and increase of the range of movement. After the implantation of the prosthesis adequate stability can be gained in knee joints without cruciate ligaments.

Author performed scintigraphic examinations for the exclusion of navicular fracture, to follow the consolidation of the pseudarthrosis of the navicular bone and to demonstrate the osteoarthritis of the wrist joint. He states that bone scintigraphy is a help in the differential diagnosis of the fracture of the navicular. Conclusion may be drawn concerning the circulatory state of the bone. The consolidation of the pseudoarthrosis may be followed and the severity of the osteoarthritis of the carpal joint can be determined.

For the major requirements of the operative technique and other special problems of operation it is reasonable to discuss among the questions of the reduction of CHD the reoperations and the reconstructive surgery of hips, badly damaged by the conservative treatment, separately. We have analysed the results of 19 own cases with an average follow up of 6.3 years (3-12 years). The average age of the patients was 4.8 years. In 7 patients only conservative treatment was carried out previously, the others were also operated. The Roentgenogram revealed severe ischaemic necrosis in 10 hips. The dislocation could be reduced in every case, to the reduction however it was obligatory to add femoral osteotomy and correction of the acetabulum. The later operation was performed frequently in the second sitting. As a direct result of the operation a state, corresponding to the II. degree of Severin's radiological classification was always reached, in cases of severe ischaemic necrosis however the result later grew worse and at the follow up it corresponded only to the degrees III. and IV. (mediocre, poor). Thus the circulatory damage, suffered during the early treatment determined the late results. This was the reason that the result of the follow up examinations were better in patients in whom early surgery was performed than in patients with forced conservative treatment. The results summarized fall far behind the results of the group with primary surgery of the CHD. Without the operations described these patients would live as limping cripples, with these operations however we have improved their state significantly for the time until TEP can be performed.

Substitution of lateral malleolar ligament with a periosteal flap Authors describe their operative procedure for chronic instability of the lateral malleolar ligament: substitution of this ligament with a periosteal flap. This operation is suitable, according to follow up examinations, both in isolated talofibular and talofibular-calcaneofibular ligamental deficiencies, for the stable restitution with good function of the talorural joint. The advantage of the operation is that less burden is imposed on the patient, the technique is relatively simple, and the need of instruments is minimal. Control examinations have shown very good or good results in the majority of 16-49 years old operated patients.

In the treatment of malacia of the lunate bone, beside the prosthesis and procedures aiming the decrease of load, the revascularization of the bone is the third basic therapeutic principle. One possibility of the later, not yet current in this country, is the implantation of the metacarpal vascular bundle in the lunate bone. As far as we know we were the first to perform this operation in Hungary. In this paper our first cases are described together with a detailed description of the operative technique and we would call at the same time to further common examinations.

In the Department of Traumatology of the "Kaposi Mór" County Hospital 213 patients with the fracture of the proximal end of the tibia were treated during 10 years (1980 + 89). 165 operated cases are analysed, 120 of them could be controlled 1.5-9 years after the operation. The importance of the reconstruction of the articular surfaces is stressed and attention is called to the increased possibility of infection in these operations.

Behind the diagnosis of "distorsio carpi" frequently ligamental injuries with severe functional damage of the carpal joint are hidden. To clear these is, in a significant part of the cases, also in the outpatient department possible if both the clinical (physical) and radiological examinations are carried out with adequate accuracy. Author deals with the "algorithm", summarizing the sequence of these examinations. If, in major complaints, it was not possible to make a diagnosis, an arthroscopy of the carpal joint is suggested.

In the last four years we performed 182 osteosynthesizes with Dynamic Hip Screw, besides other methods on the fractures of the hip region. Here we are presenting the evaluation of our results, which, regarding the international scene, fall into the medium category. The operations were performed within three days after the injuries in 61 per cent of our patients. Our results are good in 80 per cent of our patients. The incidence of method-specific complications is 15 per cent in our statistics/such as wound haematomas, local infections, cut out of the device of the femoral head, metal failures, the fracture of the femur at the site of the introduction of the device). The rate of complications is 30 per cent in case of Ender nailing. More than a 1 cm shortening in the fracture after weight bearing was observed in the 47 per cent of our DHS cases. Patients who are complaining of pain during weight bearing belong to this group. In accordance with other authors, we consider the DHS osteosynthesis, due to its high stability, the best technique in case of unstable pertochanteric fractures of elderly patients. We recommend the angular plate fixation to the pertrochanteric fractures in young patients, in whose case it requires a more accurate reposition and who are able to walk without weight bearing. We can achieve good results with Ender nails in case of stable pertrochanteric fractures of elderly patients.