Der Unfallchirurg
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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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Chest sonography after blunt thoracic trauma allows the immediate institution of emergency treatment before X-ray examination. Especially in cases of hemothorax or/and hemopericardium, ultrasound is more specific and sensitive than conventional X-ray. A definite diagnosis of pneumothorax is possible when the typical sonographic findings are present: there is a strong line of reflexes along the chest wall, with complete extinction. ⋯ In 2 cases rupture of the diaphragm seemed possible on ultrasound but was excluded by later (ultrasound) controls, and in 2 cases with ultrasound findings suggestive of pneumothorax subsequent X-ray examination confirmed the diagnosis of mantle pneumothorax. At follow-up, 29 pathologic findings according to radiographic examination were recognized on ultrasonography as liquid or organized pleural effusions or pulmonary infiltrates. False-negative or false-positive findings (apart from two supposed diaphragmatic injuries) were not recorded with ultrasound.(ABSTRACT TRUNCATED AT 250 WORDS)
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In our population of trauma patients abdomino-perineal impalement injuries are very rare. With reference to our own patients we demonstrate the problems that arise with impalement injuries: infection, hemorrhage, intraabdominal organ lesions and difficulty in recognizing these. ⋯ In our own patients we have always tried to achieve definitive therapy as a primary procedure. There have been no lethal complications.
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Comminuted fractures of the olecranon are an absolute indication for operative treatment. Adequate therapy is only possible when open reduction and plating are performed. In the last 20 years, 31 of our patients, i.e. 0.0001% of all patients treated for injuries, had this type of olecranon fracture, and in 25 follow-up examination was possible. ⋯ Brief plaster fixation after the operation makes it possible to restrict the development of ankylosis in the elbow joint. The results were excellent in 10 patients, good in 5 patients, fair in 4 and poor in 6 patients. In 3 patients, i.e. 10% ankylosis was present in the elbow joint; this was considered to constitute an indication for arthroplasty, which gave a better postoperative range of motion.
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The presence of soft tissue defects in the hand indicates serious traumatic damage that may compromise the systems involved in movement, circulation or touch and therefore jeopardize functional rehabilitation. This overview highlights the significance and the various causes of soft tissue defects. ⋯ The characteristics required of flap tissue are described, such as surface characteristics, ability to restore sense of touch, cosmetic appearance, ability to close deep volume defects, and potential for revascularization of adjacent tissue. Finally, commonly used, selected flaps are presented with notes on their advantages, disadvantages, and modifications, the techniques required and the indications for each.