Der Unfallchirurg
-
Comparative Study
[Proximal interlocking of humeral intramedullary nails and risk of axillary nerve injury].
Possible injuries to the axillary nerve are criticised in antegrade and retrograde endomedullary nailing of the humeral shaft during proximal interlocking. Clinical experience seems not to support the theory of a high risk of nerve injury. The real risk although remains unknown under anatomical-morphological aspects. ⋯ We suggest to perform only a sharp cutaneous incision and then to prepare the muscle only by careful spreading until touching bone, with tissue retraction during drilling. In retrograde nailing the dorso-ventral bolt should only be used in extreme proximal fractures.
-
A 21-year-old man experienced an open knee injury with a subtotal loss of the medial part of the distal femur. After an initial debridement of the wound we performed 48 hours post injury an allogeneic transplantation of the condyle of the femur. ⋯ The bone transplant hadn't been treated specifically prior to the transplantation and the patient didn't receive any immunodepressive drugs. 18 months later, the patient is able to flex the knee joint up to 120 degrees and to extend it completely. The overall result is excellent.
-
During the last years minimal-invasive augmentation techniques of vertebral bodies have been established to stabilize painful height losses. A vertebroplasty fills the vertebral body with cement, whereas a kyphoplasty intends to achieve a reduction of kyphosis prior to cementing. The present review describes both techniques and summarizes in vivo and in vitro experiences.
-
Radial nerve palsy is a rather frequent complication caused by an accident as well as by surgery of the humerus. As a primary, i.e., accidental lesion, its incidence as stated in the literature is up to 30%, primarily fractures in the distal diaphyseal half. Secondary, i.e., surgically induced, nerve lesions surprisingly are reported with a similar frequency, though recently the incidence only approaches some 3%. ⋯ The stand we take in this controversy is instant revision surgery both for accidental lesions as well as uncompromisingly for those incurred during surgery when the surgeon had not explored the nerve far enough to preserve it during the operation. Three exemplary cases are reported, one of them submitted for an expert's opinion because of an alleged mistake on the part of the doctor. Forensic responsibility has to match actual indication principles and the specific technique applied.
-
Case Reports
[In situ connection of a hollow intramedullary nail to the stem of a knee prosthesis in periprosthetic fracture].
Periprosthetic fractures often reveal problems and complications because of poor bone quality. A case report is presented, in which a hollow intramedullary nail was connected, in situ, with the stem of a knee prosthesis (Blauth knee). ⋯ As ultima ratio, a hollow intramedullary nail was placed antegrade on the stem of the knee prosthesis. Afterwards excellent callus formation developed and resulted in consolidation.