Der Unfallchirurg
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Patients with fractures of the pelvic ring and accompanying injuries special of the extremity make heavy demands on hospital resources and face difficulties in rehabilitation. From the patients point of view milestones in recovery are quality of live and return to productivity. We studied 64 patients with pelvic-ring-fractures in a period of 10 years. ⋯ PTS-score and AO-classification correlate directly to long-term disability, based on Rosser-Index, and "return to productivity" figures but not always to radiological and clinical outcome. This study emphasizes the need for new injury scoring systems that better predict the recovery and ability to return to work of trauma patients after surviving unstable pelvic fractures. Proper follow-up evaluations should analyse the patient's quality of live and working activity beside traditional item like radiological and clinical findings.
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Cervical spine changed by Bechterew's disease is severely endangered with any increased load. Even decent trauma is enough to produce a fracture with affection of spinal cord. Because of little knowledge in these special items, late diagnosis of overlooked injury is not rare, especially in two-level injuries. ⋯ There were four patients, that would not have suffered cervical spine fracture (minimal injury force) without Bechterew's changes. There is often pulmonary failure through limitation of thoracic movement and cerebral ischemia following rupture of vertebral arteries as typical complications. Mortality (2 cases; 16%) in our collective is less than literature's medium rates (35-57%).
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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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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.