Der Unfallchirurg
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The clinical results after DFN-osteosynthesis of n=56 AO-classification 33A-fractures (32%), 33C-fractures (43%), 32X-fractures (21%) and pseudarthrosis treatment (4%) are presented. ⋯ The mechanical stability of the implant allows a save osteosynthesis of unstable supracondylar and complete articular femoral fractures without additional bone grafting. Mechanical stability and minimal invasive operative technique permit a safe bone healing without major complications.
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The hypothenar hammer syndrome (HHS) is a rare form of secondary Raynaud's phenomenon in workers who frequently use the ulnar side of the palm as a hammer. Clinically the patient with HHS shows neurologic symptoms such as paresthesia, numbness and pain and signs of vascular insufficiency such as coldness, pallor, discoloration and blanching of the affected ulnar sided fingers. The diagnosis is verified by angiography, showing thrombosis or aneurysm of the distal ulnar artery. ⋯ But with the ongoing working habit of using the hand as a hammer there is always the risk of a recurrence. Therefore the job environment has to be changed considerably and the most effort should go into prevention and prophylaxis. If the change of the working habit is not possible, the job is clearly at stake.
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A higher-than-average rate of aseptic loosening has been postulated to be associated with the combination of a titanium stem and bone cement. In this prospective follow-up study we therefore investigated our first consecutive series of 250 implantations of a cemented femoral shaft prosthesis made of titanium alloy (BiCONTACT((R)), Aesculap, Tuttlingen, Germany). Average time of follow-up evaluation was 9.7 years (range 8.7-10.3 years). ⋯ In conclusion, the long-term follow-up results with this cemented titanium femoral component are encouraging and are comparable to other successful cemented femoral components in primary total hip arthroplasty. No increased risk for aseptical loosening was associated to the combination of titanium and cement in this specific stem. Design parameters seem to play an important role in the development of aseptic loosening in cemented titanium stems.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Clinico-histologic comparison of allogenic and autologous bone-tendon-bone using one-third of the patellar tendon in reconstruction of the anterior cruciate ligament].
Reconstruction of the ruptured anterior cruciate ligament (ACL) using modern techniques achieves successful long-term results in up to 90% of all cases. Yet the discussion continues as to the suitable implant to replace the ACL in terms of donor morbidity, implant reaction, long-term results, and potenzial risk of carrier concerning the allograft. The clinical and histological results from 2 years experience with the BPTB allograft (Tutoplast) and the BPTB autograft for ACL reconstruction are compared with reference to stability, functionality, rerupture rate, and histological reaction of the remodelling process. ⋯ There were clearer and more protracted indications of hypercellularity and hypervascularity, and the collagen matrix had not regularly aligned longitudinally even 1 year later. A detailed analysis of the BPTB allograft group indicated that especially in young and very sporty patients there is increased elongation of the implant and a clearly higher rerupture rate. Hence, according to the data we have collected, it would seem that the use of the BPTB allograft (Tutoplast) is not suitable especially in young patients who frequently practice high-level sports involving high knee stress.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Reduction of severe cardiac complications during implantation of cemented total hip endoprostheses in femoral neck fractures].
Intraoperative circulatory and pulmonary problems occuring during the repair of femoral neck fractures with cemented hip arthroplasty are a common problem, that cannot be ultimately explained. As a possible reason for this problem is air embolism during the polymerisation of the methylmethacrylat discussed. We started a prospective randomised clinical examination with 72 patients to prove the efficiency of palacos mixed in vacuum, with respect to the reduction of severe cardiovascular complication during endoprosthetic repair of femoral neck fractures. ⋯ Mortality in the control group amounted to 13.8% in the vacuum group to 2.8%. Through the use of methylmethacrylate mixed in vacuum for surgical repair of femoral neck fractures with cemented hip arthroplasty, the incidence of severe cardiac complications could be reduced significantly. Patients with increased pulmonal arterial pressure have the highest risk for cardiac complications.