Der Unfallchirurg
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Tissue defects of the heel region are a challenging problem. Various reconstructive techniques were performed in 44 patients with 59 defects around the heel region, who were treated between 1994 and 1999 following a traffic accident in 27%, a burn injury in 25%, and other traumatic causes in 48%. ⋯ The overall complication rate was 18% with the highest rate after local flap procedures. A therapeutic strategy was developed, which is based mostly on the localization and extension of the defect area.
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The complex pathophysiology of electrical injury is caused by several mechanisms which are superimposed and cumulative in action. Existing empirical guidelines are only partially compatible with the results of recent studies. The significance of the joule effect, theories about progressive tissue necrosis, and the traditional surgical approach should be reviewed in view of electroporation and anatomical arrangements. The quality of long-term treatment results and the consistently high rate of amputations have prompted the development of alternative surgical options.
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Comparative Study
[Influence of prosthesis design on intramedullary pressure formation in femur shaft implants of cemented hip endoprostheses].
The increase of intramedullary femoral pressure can lead to the intravasation of bone marrow and fat cells into the blood stream of the femoral vein and consequently into the pulmonary circulation. This effect is the same in intramedullary nailing and in the implantation of femoral stem prostheses. In a prospective study we evaluated the intraoperative, intramedullary pressure in the distal femur during the implantation of femoral stem prostheses with two different designs. ⋯ The differences were statistically significant (p = 0.0008). By changing the designs of femoral stem prostheses, the intramedullary pressure can be markedly reduced. In the case of elderly patients or those with pulmonary illness we recommend femoral stem prosthesis designs, which induce little increase in the intramedullary pressure, in order to reduce cardiopulmonary complications.
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Comparative Study
[Diagnostic value of conventional roentgen image, computerized and magnetic resonance tomography in acute sprains of the foot. A prospective clinical study].
In order to gain satisfying results in the treatment of acute hyperflexion trauma to the foot, it is absolutely necessary to achieve an exact primary diagnosis because injuries to the tarsometatarsal joint are frequently missed primarily. Aim of this prospective clinical study was to evaluate the diagnostic reliability of conventional radiography, CT and MRI compared to each other. 75 consecutive patients after hyperflexion trauma to the foot were included. There were 47 males and 28 females with a mean age of 38 years. ⋯ Additionally, partial or complete tears of Lisfranc's ligament were depicted in 22 patients. The present study could clearly show the superiority of CT and MRI to conventional radiography in diagnosis of bony and ligamentous disorders of the Lisfranc joint. Therefore, extended diagnosis has to be demanded in all cases of hyperflexion trauma to the foot.
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C-arm navigation is a new tool in computer assisted surgery. The aim of this study is to evaluate the accuracy of Iso-C-arm based drill holes in the proximal femur. In nine artificial proximal femura, two holes with an angle of 135 degrees and 100 degrees in relation to the shaft axis were drilled in the direction of the femoral head. ⋯ The main plane of deviation in all of the 135 degrees holes was posteriorly, whereas in the 100 degrees holes posterior deviation occurred in four cases, cranial in three cases, and in one case each caudal and anterior deviation occurred. In our opinion, the accuracy of fluoroscopy based navigation applied in the region of the proximal femur is sufficient and reproducible. This technique can be used for implant placement at the proximal femur in the future.