Der Unfallchirurg
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In a retrospective study of 59 patients the results obtained with elbow arthrolysis performed for the treatment of posttraumatic stiffness were analyzed. The intraoperative functional result was classified as excellent in all cases, while an average of 27 months after the operation the range of movement was decreased again to varying extents. This deficit correlated with the type of injury, timing of arthrolysis, duration of metal implants and timing and type of postoperative rehabilitation program. ⋯ The results show that the prognosis of elbow arthrolysis is determined by optimal operative planning and a meticulous rehabilitation program. The time to arthrolysis should be as short as possible, as should the time to removal of metal implants. The aim of the rehabilitation program is immediate postoperative mobilization.(ABSTRACT TRUNCATED AT 250 WORDS)
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The data recorded in 10 multitrauma patients who died of respiratory insufficiency (ARDS) were retrospectively compared with corresponding data recorded in 10 patients with similar injury scores who survived. All 20 patients had had respirator therapy from the 1st day onward. The criteria for ARDS were: (1) death in respiratory insufficiency after trauma. (2) chest X-rays showing signs of ARDS, (3) continuous decrease in the Horowitz quotient, and (4) autopsy (50% of the patients). ⋯ In survivors the Horowitz quotient increased up to physiological values on the 2nd day. A significantly higher PEEP from the 3rd posttraumatic day onward was needed in ARDS patients. The respiratory peak-pressure increased significantly from the 2nd posttraumatic day.
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Biomechanical studies were carried out to assess the function and performance of intramedullary (IM) nails for femoral fractures. An appropriately sized femoral IM nail with a radius of curvature of about 109 cm would most closely match the anterior bow of most human femora. A number of parameters can interact to result in bursting of the femur during insertion of the nail. ⋯ Slotted IM nail/femur constructs have only about 3% the rigidity of the intact femur in torsion, while an unslotted (closed) section implant produces constructs with about 50% the rigidity. The distal locking bolts increase the torsional rigidity and maximum axial load capacity of the construct, and reduce the potential for shortening and the residual deformation upon release of a torsional load. Two distal bolts reduce the toggle of the nail in the femoral shaft.(ABSTRACT TRUNCATED AT 250 WORDS)
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Patellofemoral loads are calculated by means of a mathematical model based upon an elliptical approximation of the articulating profile. Differences in the sagittal curvature of morphological and arthroplastic gliding surfaces can be approximated by a differing eccentricity of the ellipse. The joint is balanced in a static situation by two tension forces. ⋯ The model also takes into account the patellar ligament turning around the proximal tibia at wide flexion angles. Besides the design of the prosthesis, patellofemoral loads depend on the height of implantation of the femoral component. It must be borne in mind that forces will vary in magnitude at different flexion angles; the patient's activities after the operation must also be considered.
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Fracture dislocations of the cunei-navicular joints are a very rare type of intertarsal dislocation and most people are probably unfamiliar with this entity. Clinical, radiological and pathological aspects allow discrimination of such injuries from the dislocations in Lisfranc's and Chopart's articulation. We have seen one patient who was found to have a crush fracture of the cuneiforme mediale on one side and a fracture disruption with dorsal dislocation of the first and second metatarsals and of the medial and intermediate cuneiform bones on the other. According to the principles of treatment for other tarsal injuries, we carried out open reduction with joint debridement, reconstruction of ligaments and internal stabilization with transfixation screws.