Der Unfallchirurg
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Case Reports
[Ultrasound detection of rib fractures for verifying fracture diagnosis. A pilot project].
Since the diagnosis of rib fractures caused by blunt thoracic trauma is often missed on X-ray, attempt have been made to detect unknown fractures with ultrasound. Ultrasound was initially researched, as a diagnostic technique in a preliminary study of 10 patients with known rib fractures. Subsequently, in the main study, 21 patients with clinically suspected rib fractures but normal thoracic X-rays were examined with ultrasound, and rib fractures were detected in 16 patients. ⋯ This finding is explained by the presence of nondislocated rib fractures that are veiled to ultrasound when a disconnection of the rib's contour is missed during respiration. The diagnostic procedure is explained with reference to case studies. In summary, findings recorded in this study showed that ultrasound investigation is a more reliable method of diagnosis than X-rays examination.
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Multicenter Study
[Femoral neck fractures in adults: joint sparing operations. I. Results of an AO collective study with 328 patients].
In a multi-center study in 14 trauma hospitals 328 patients with fractures and osteosyntheses of the femoral neck were investigated with reference to time between accident and operation implants used, early and late complications, and results in the years from 1974 to 1987. A follow-up examination was possible in 266 patients a mean of 46.7 months after their accidents. General postoperative complications were recorded in 12.2% and local complications in 11.6%. ⋯ The best results (significantly better than in other groups) were obtained in patients who were operated on early (< 24 h after trauma) (P < 0.05) and those in whom dynamic hip screws (DHS) were used (P < 0.01). Of all cases of aseptic necrosis 70% were seen within 3 years and 86% within 6 years after trauma. The rate was dependent on the degree of dislocation of the fracture (Garden III and IV), the time from trauma to operation, and the implant used (130 degrees blade plate 30.5%, DHS 9.2%).
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High-voltage injuries cause localised entrance and exit burns, extensive arc, flame and flash burns and, even more dangerous, necrosis of the underlying muscles on the pathway of the current through the body. Therefore it should be recognized that the ensuing disease is more like a crush injury than a thermal burn. The extent of injury cannot be judged by the percentage and depth of the skin burn. ⋯ Ten patients (23.3%) sustained fractures and other injuries from falls, seven (16.3%) of them severe polytrauma. Initial cardiac arrhythmics were diagnosed in 16.6% of the primarily treated patients. Thirty per cent of our patients had neurological complications such as peripheral paresis, tetraplegia and paraplegia, 20.7% of these caused solely by the electric current.
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There is a world-wide growing interest in cultured epithelium. It is commonly accepted that cultured epithelial auto- or allografts can stimulate wound healing and shorten re-epithelialization time. Sheets of cultured autologous epidermal cells have been used for more than 15 years as grafts to achieve permanent coverage of full-thickness burn wounds. ⋯ Especially burn wounds of the face have been treated successfully, avoiding over-grafting and achieving highly acceptable, aesthetic and functional results. Many laboratories are developing dermal equivalents, combining synthetic and biological materials in order to form a multilayer neodermis. Although it seems possible to cultivate adnexae of the skin, a neodermis with cultivated adnexae is not yet in sight.
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Internal fixation of unstable intertrochanteric fractures of osteoporotic femurs often leads to complications, which are primarily caused by the mechanically weak bone. The aim of this study was to test whether a new glass-ionomeric cement could reinforce the weak trabecular bone of the femoral head and thus improve the preliminary stability of dynamic hip screws (DHS) used for internal fixation. As a standardized model, a intertrochanteric osteotomy was performed on eight pairs of human, female, cadaver femora; a bony defect was also created medially to diminish support of the femoral neck. ⋯ The irreversible movement of the femoral head was significantly larger, approximately twice as great, following uncemented DHS fixation than after cemented fixation. Most movement occurred during the first ten load cycles; higher load cycles did not increase the irreversible deformation in the cemented group, but in the uncemented group a further increase in deformation was detected. These results indicate that internal fixation of unstable intertrochanteric femoral fractures can be significantly improved by the use of cement.(ABSTRACT TRUNCATED AT 250 WORDS)