Der Unfallchirurg
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Modern molecular and genetic technologies enable the modification of a cellular genome through transfer of specific genes. The various procedures alter specific cell functions, which allow the transfected cell to produce any encoded transgene information. ⋯ Currently, further animal studies are evaluating new vectors with reduced immunogenicity in the continuous effort to improve the efficacy and safety of gene transfer. In the forthcoming decade we expect gene therapy to have an important influence on the treatment of fractures, cartilage lesions, and infection.
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Review Case Reports
[Diagnosis and treatment of the Essex-Lopresti lesion. Literature review and four case reports].
A fracture of the radial head in combination with a rupture of the interosseous membrane and lesion of the distal radioulnar joint known as Essex-Lopresti lesion is a rare injury. Usually it is caused by a high-energy trauma. Initially unrecognized distal radioulnar dislocations often show poor results. ⋯ An early diagnosis is the key for the correct treatment of an Essex-Lopresti lesion based on the classification of Edwards and Jupiter. In addition to the clinical and radiological assessment ultrasound should be used to diminish the rate of unrecognized interosseous membrane disruptions.
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Clinical Trial
[Not "only" a dislocation of the hip: functional late outcome femoral head fractures].
Traumatic hip dislocation combined with fracture of the femoral head is a rare condition for which little known in terms of long-term prognosis. The aim of the retrospective study presented here was to evaluate the clinical and radiological outcome of this specific injury. ⋯ Quality of life was not reduced in most patients in the long term, however three of four patients suffering Pipkin type-IV fractures developed functional restrictions with poor results. We conclude that acute reduction of the dislocated joint and anatomical reconstruction of the femoral head instead of primary hip replacement may end in good to excellent results in type-I and type-II fractures. Due to the young age of these patients, joint reconstruction should always be the first choice even in type-IV fractures with a higher probability of poor prognosis.
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Acute shoulder dislocation is a common injury and characterized by an extremely painful lack of motion. The treatment objective after diagnosis is immediate reduction avoiding additional pain and complications. Various techniques have been described for more than 2000 years mostly using traction-countertraction, particularly combined with special positioning and leverage maneuvers. ⋯ In ten patients general anesthesia was required to achieve reduction. No complications occurred in any of the patients. The reported technique allows a gentle and painless reduction of acute anterior shoulder dislocation with a high success rate mostly avoiding premedication.
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Bipolar dislocation injury of the forearm is rarely documented. It is a combined forearm injury with trauma on the elbow side and on the side of the wrist joint. ⋯ The second person had an acute longitudinal radioulnar membrane dissociation after elbow dislocation with an additional scapholunate tendon rupture. The difficult management of these injuries is illustrated by these cases.