Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Fractures of the proximal femur are typical injuries of the elderly. Therefore immediate restoration of weight-bearing capacity and prevention of local complications with the need for of secondary surgical procedures are very important. ⋯ The weight-bearing capacity of the GN (4,230-5,557 N) was about 100% higher than that of the DHS (2,465-3,049 N). The total deformation was 1/3 higher for the DHS (17.3 +/- 2.06 mm) than for the GN (10.73 +/- 4,33 mm). After 100,000 alternating load cycles no instability and a total deformation of 13.3 mm was found for the GN, but for the DHS instability occurred after 15,800 cycles. The migration of the I-beam GN plate at 1,000 N in sowbone femora was 0.7 mm for the gamma screw 1.69 mm and for the PFN 2 mm but one cut-out was observed. At 1,500 N the difference are even higher, all three PFN showed a cut-out and in two of the three gamma screws rotation of the head and neck around the screw was observed. In the cadaver tests similar differences were found with a migration at least double that of the GN I beam plate for the gamma screw and the PFN double-screw fixation. There was no difference between the gamma and PFN fixation in the cadaver pair test.
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In association with perforating or blunt trauma, isolated injuries of the trachea and the bronchi are rarely seen. More frequently, however, they occur when adjacent organs or structures are involved, thus creating very complex syndromes. Symptoms such as dyspnea, coughing attacks, hemoptysis, soft tissue emphysema, cyanosis, and pneumothorax should point to severe tracheobronchial injuries. ⋯ With spontaneous healing never occurring, surgical repair is carried out ideally by closing both openings in chronic fistulas, while simultaneous tracheal stenosis is treated by segmental resection. Tracheoarterial fistulas, mostly associated with tracheostomy, become fatal if not detected immediately. Definitive repair requires the resection of the vascular segment involved.
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The application of endoscopic techniques is common in the treatment of tracheal and bronchial diseases today. Bronchoscopic interventions are used in both elective and emergency situations. Laser therapy for malignant tumors is purely palliative in most cases and should only be performed in nonsurgical patients. ⋯ The use of therapeutic bronchoscopy requires great experience in rigid and flexible bronchoscopy, the possibility of high-frequency jet ventilation as well as laser and argon application, and the possibility to implant different types of stents. More advanced bronchoscopic interventions should only be done if a department of thoracic surgery exists, in view of the potential need to control complications or perform further treatment. Especially the bronchoscopic treatment of tracheal stenosis should be performed by the thoracic surgeon himself or in close contact with a thoracic surgeon who is experienced in tracheal resections.