Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera最新文献

While soccer playing a 19 year old man suffered from acute onset of severe pain in the anterior part of the iliac crest. A CT-scan confirmed the unilateral avulsion of the anterior superior iliac spine. Due to only minimal fragment dislocation and still open apophysis we decided to treat this injury conservatively with crutches and partial weight bearing. There were no complications and already three weeks after the accident the young man was nearly painfree. Avulsion of the anterior superior iliac spine most commonly occur in adolescents. The fracture is often missed and treated as muscle injury or hip pain and therefore received a symptomatical therapy. Later a typical hypertrophic callus formation confirms the avulsion fracture. The avulsion occurs by sudden pull of the sartorius muscle to the anterior superior iliac spine. The pull of the muscle dislocates the loose fragment caudally. In most of the cases a conservative treatment is successful.

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

Based on the classification of pseudocysts according to D'Egidio and Schein the different surgical techniques for the treatment of pancreatic pseudocysts, i.e. drainage procedures and resections are discussed. The role of laparoscopic techniques is demonstrated. The "competing" endoscopic and interventional techniques are mentioned. The prognosis of the patients after operations for pancreatic pseudocysts is to a smaller degree depending on the operating technique, but largely on the natural history of the disease and the discontinuation or continuation of the underlying pathogen.

Surgery for Crohn's disease is restricted to the treatment of complications. Even then, nearly all patients with Crohn's disease must be operated on at least once in lifetime. Surgical concepts base on the right timing for the operation, interventional drainage of abscesses, accurate pre-operative work-up to determine the extent of inflammation, and bowel conserving operation techniques. Respecting these principles, surgery for Crohn's disease can be performed with low complication rates restoring in most cases patients' quality of life.

Introduction: Combined injuries of the capitellum humeri and the radial head are rare. Most of them show combined osteocartilaginous lesions and collateral ligament lesions. Recommendations for treatment of these fatal injuries of the elbow are missing.

Type of study: Five cases were investigated in an retrospective analysis. The same approach was used for the osteocartilaginous lesion of the capitellum as well as the injury of the radial head. Internal fixation was done with mini-titanimplants, three of them combined with resorbable pins.

Patients and methods: Between 1996-1999 five patients (four men, one woman) with combined injury of the radial head and the capitellum were stabilized. The average age was 34 years (31-40 years). All fractures were stabilized by a direct radial approach with 1.5 mm or 2.0 mm lag screws partly with resorbable pins. All patients were evaluated radiologically and clinically according to the Mayo-elbow-performance score.

Results: All patients were personally examined after an average period of 12.8 month (8-24 month) by an independent investigator. 4/5 patients were assessed for their satisfaction. No radiological signs of avascular necrosis of the capitellum or arthrosis were found. Three patients showed periarticular calcifications. The range of motion was averagely 124 degrees (extension 5-30 degrees, flexion 110-145 degrees), in three of five cases a secondary intervention for improvement of joint mobility was necessary. The Mayo-elbow-performance score rated for 85 points in average (range 70-100 points).

Conclusion: Direct screw fixation with mini-implants, eventually combined with resorbable pins allows to use the same approach for anatomic reconstruction and fixation of the capitellum humeri and radial head. Transarticular fragment fixation of the capitellum allows for safe compression. Therefore early functional rehabilitation is possible postoperatively. Secondary interventions for improve joint motion were necessary in three of five cases.

Purpose: To review, retrospectively, the possible causes of sub- or intertrochanteric fractures after screw fixation of intracapsular fractures of the proximal femur.

Methods: Eighty-four patients with an intracapsular fracture of proximal femur were operated between 1995 and 1998 by using three cannulated 6.25 mm screws. The screws were inserted in a triangular configuration, one screw in the upper part of the femoral neck and two screws in the inferior part. Between 1999 and 2001, we use two screws proximally and one screw distally.

Results: In the first series, two patients died within one week after operation. Sixty-four fractures healed without problems. Four patients developed an atrophic non-union; avascular necrosis of the femoral head was found in 11 patients. Three patients (3.6%) suffered a sub- and/or intertrochanteric fracture after a mean postoperative time of 30 days, in one case without obvious trauma. In all three cases surgical revision was necessary. Between 1999 and 2001 we did not observe any fracture after screwing.

Conclusion: Two screws in the inferior part of the femoral neck create a stress riser in the subtrochanteric region, potentially inducing a fracture in the weakened bone. For internal fixation for proximal intracapsular femoral fracture only one screw must be inserted in the inferior part of neck.

The authors evaluated ten years of surgical reanimation in the University Centre of Lausanne (CHUV). Irreversible coagulopathy (IC) is the predominant cause of death for the polytraumatized patient. Acidosis, hypothermy, and coagulation troubles are crucial elements of this coagulopathy. The authors looked for a criterion allowing the identification of dying of IC. In a retrospective study, laboratory results of pH, TP, PTT, thrombocyte count and the need for blood transfusion units were checked for each major step of the primary evaluation and treatment of the polytraumatized patients. These results were considered as critical according to criteria of the literature (30). The authors conclude that the apparation of a third critical value may be useful to identify the polytraumatized patient at risk of dying of IC status. This criterion may also guide the trauma team in selecting a damage control surgical approach (DCS). This criterion was then introduced into an algorithm involving the Emergency Department, the operating room and the Intensive Care Unit. This criterion is a new tool to address the patient at the crucial moment to the appropriate hospital structure.