Der Unfallchirurg
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Whereas the Scottish guidelines are audited annually, nobody evaluates guideline compliance in Germany. Thus, can external quality assurance data pursuant to section 137 of the German Social Code Book V be suitable for auditing guideline compliance? ⋯ Guideline compliance is similar in German and Scotland. The external quality assurance data are suitable for evaluating guideline compliance. The literature recommends a short time to surgery. Given the short observation period, it was not possible to demonstrate any improvement in outcomes.
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According to the literature, differences in torsion of 15 degrees and more develop in 20-30% of cases after intramedullary nailing of femoral shaft fractures. A computer-assisted method makes it possible to determine the antetorsion angle during surgery. In this experimental study, the precision of the measurements obtained with the navigation system were checked with a femur model and compared with a CT reference method. ⋯ When comparing the absolute values of the navigation and reference systems, the mean deviations of both methods are around 1 degrees (0.35; 1.75) and comparing the differences 0.5 degrees (-0.2; 1.17). The maximum deviation of the absolute values of the CT reference method amounts to 6.4 degrees. Under experimental conditions, measurement of the femoral antetorsion angle proved to be sufficiently precise for clinical specifications in comparison to a CT reference method.
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Comparative Study
[Proximal femur fractures: results and complications after osteosynthesis with PFN and TGN].
The primary aim of surgery for pertrochanteric fractures of the femur is to regain preoperative mobility as quickly as possible. The aim of this study was to investigate whether clinical or radiological differences could be found between proximal femoral nails (PFN) and trochanteric gamma nails (TGN), with particular attention given to technical differences in implantation and early complications. ⋯ PFN are better suited to 31A1 fractures because of their higher rotational stability from the use of dual screws. A short femur and high antecurvation can cause insertion problems in PFN because of the nail design. It is advisable to choose the type of implant during preoperative planning after considering fracture type and patient anatomy.
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We report the case of a 17-year-old boy who was hit by a high velocity train. The polytraumatized patient suffered a 3 degrees open femur defect fracture with a substantial loss of the lateral femoral muscles and significant disruption of the soft tissue of the lower leg. The enormous wound areas on the thigh and the lower leg were infected by Pseudomonas aeruginosa, Enterobacter cloacae, and Stenotrophomonas maltophilia. ⋯ A. C. Instill seems to offer great possibilities in critically infected wound situations.
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We report on a 16-year-old boy with deformity of the forearm with painful functional limitation after a fracture of the distal radius associated with an unapparent lesion of the distal physis of the ulna suffered 4 years earlier. The lesion caused premature growth arrest in the ulna and a bowing of the distal radius with a carpal slip. It was treated with a corrective osteotomy in the radius together with a lengthening of the ulna, with excellent functional results.