Der Unfallchirurg
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Comparative Study
[Biomechanical stability with a new artificial vertebral body implant. 3-dimensional movement analysis of instrumented human vertebral segments].
The authors present a new implant for vertebral body replacement in the thoracic and lumbar spine. The titanium implant is designated for reconstruction of the anterior column in injury, posttraumatic kyphosis or tumor of the thoracolumbar spine. The instrumentation has to be supplemented by a stabilizing implant. After positioning, the implant is distracted in situ, through which best contact to adjacent end-plates and 3-dimensional stability should be provided. The possibility of secondary dislocation or loss of correction should thereby be minimized. ⋯ The posterior fixation was found to offer superior stability compared to the anterior one. Synex was at least comparable to MOSS for suspensory replacement of the vertebral body in the thoracolumbar spine. The evidence of higher biomechanical stability with Synex leads to the probability of a higher rigidity in vivo. Due to the distractability of Synex, a better intervertebral compression was achieved. Therefore, an additional tightening of the posterior fixator after insertion of Synex was not necessary, in contrast to the Harms cage.
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The objective was to evaluate mid-term results after arthroscopic subacromial decompression (ASD) with special focus on the bias due to an application to social insurance for pension based on sickness disability. The study group consisted of 42 patients (28 male, 14 female). ASD was performed in 1993 or 1994 for impingement stage II. ⋯ The Constant score improved from 49.6 +/- 18.5 to 84.8 +/- 14.3. The subgroup of patients having applied to social insurance for pension had significantly worse results compared with the remaining patients: VAS: 4.9 +/- 3.1 vs. 7.5 +/- 3.1; Constant-Score: 76.1 +/- 12.7 vs. 88.3 +/- 13.5. The fact that patients try to get benefit from social insurance based on sickness disability significantly biased the outcome after ASD.
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A patellar dislocation is usually understood to mean a lateral dislocation of the patella. Medial patellar dislocations have mainly been described after surgical treatment, such as release of the lateral retinaculum. Here a case of medial patellar dislocation is reported which did not occur subsequent to surgery. Wilberg-III patella, genu recurvatum with patella alta and a m. vastus medialis insertion widely distal to the patella were predisposing factors.
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Vacuum assisted wound closure (VAC) is a closed system, which applies negative pressure to the wound tissues. Basic studies have shown beneficial effects on wound blood flow and proliferation of healing granulation tissue. Theoretically, the method acts by removal of excess tissue fluid from the extravascular space, which lowers capillary after-load and thereby promotes the microcirculation during the early stages of inflammation. ⋯ Also, patients who are fully anticoagulated or patients with large wound surface areas (e.g., burns) may need careful monitoring of electrolytes, hematocrit, and/or fluid balance in an intensive care or burn unit setting. The mainstay of wound care is débridement, and vacuum assisted wound closure is not a substitute for this. It is a novel and welcome addition to the methods available to surgeons charged with the management of challenging wounds, and its final role in the overall list of adjunctive wound treatment modalities is still seeking a final definition.
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Modern imaging and computer technology gain more and more importance in surgery. This is true for elective and emergency diagnosis and treatment. However integration of technology and optimization of process management is severely behind. ⋯ The platform may be used for elective diagnosis, for diagnosis and therapy in polytraumatized patients in one and the same location (one stop shop) and for computer assisted surgery (CAS). Bringing the technology to the patient and not the patient to the technology can save time consuming and potentially dangerous transports and expensive personnel can be reduced. Navigation-technology and high quality intra-operative imaging expand the spectrum of minimally invasive surgery.