Open reduction for late-presenting posterior dislocation of the elbow

PURPOSE: To evaluate results of open reduction for late-presenting (more than 3 weeks) posterior dislocation of the elbow in 10 patients. METHOD: Elbow stiffness was the main indication for surgery. The mean age of the patients was 34 (range, 13-65) years; the mean time since injury was 4 (range, 2-6) months. All patients had non-functional elbow movement for any activity of daily living. Three patients had associated fractures around the elbow joint. RESULTS: At a mean follow-up of 19 (range, 11-28) months, 8 patients regained a functional range of movement for activities of daily living and maintained a median arc of flexion of 100 degrees and a supination-pronation arc of 140 degrees. According to the Mayo Elbow Performance Index, the results of 5 patients were excellent, 3 were good, and 2 were poor. Complications included pin site infection (n=2), ulnar neuritis (n=1), and delayed wound healing (n=1). CONCLUSION: In patients with late-presenting, unreduced elbow dislocation occurring up to 6 months earlier, open reduction is effective in restoring the joint to a painless, stable and functional state.     

Traumatic dislocation and fracture dislocation of the hip. A long-term follow-up study

Of 84 fracture dislocations of the hip reviewed, 73 were posterior fracture dislocations, nine were central, and two were obturator. Fifty-five were followed from one to 30 years (average, 4 1/2 years). The patients' ages ranged from three to 83 years (average, 33.1 years). All had primary attempt at closed reduction, with 15 treated with subsequent open reduction (six immediate and nine delayed). Satisfactory results were obtained in 42% of hips treated with closed reduction and 40% of those treated with open reduction. Statistical analysis of the results was done. A stable closed reduction produced results as satisfactory as open reduction. When followed for a sufficiently long time interval, severe fracture dislocations, regardless of treatment mode, caused unsatisfactory results.     

Severely displaced proximal humeral epiphyseal fractures

The purpose of this study was to document the late outcome of a group of patients with Neer grade III/IV proximal humeral physeal fractures who were treated with reduction of the fracture and maintenance of reduction until fracture consolidation. A total of 28 patients treated between 1984 and 1999 at a large children's hospital were included in this study. Nineteen of the 28 patients were 15 years or older (range 5-16 y). All patients were treated in the operating room with closed reduction followed by immobilization (n = 3), closed reduction and pin fixation (n = 20), open reduction and screw fixation (n = 3), or open reduction and pin fixation (n = 2). Postoperatively, all had Neer grade I or II displacement, which was maintained until fracture union. No operative or postoperative complications occurred. At an average follow-up of 4 years, all patients had near-normal glenohumeral motion and excellent strength and uniformly reported regaining full preinjury functional use of the involved extremity. Achieving and maintaining reduction in Neer grade III/IV proximal humeral epiphyseal fractures can be safely performed and results in excellent long-term shoulder function. This is of particular significance in the older adolescent who has minimal remodeling potential.     

Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation

Fracture-dislocations of the tarsometatarsal (Lisfranc) joints are frequently overlooked or misdiagnosed at initial presentation. This is a comparative cohort study over a period of five years comparing primary open reduction and internal fixation in 22 patients (23 feet) with secondary corrective arthrodesis in 22 patients (22 feet) who presented with painful malunion at a mean of 22 months (1.5 to 45) after injury. In the first group primary treatment by open reduction and internal fixation for eight weeks with Kirschner-wires or screws was undertaken, in the second group treatment was by secondary corrective arthrodesis. There was one deep infection in the first group. In the delayed group there was one complete and one partial nonunion. In each group 20 patients were available for follow-up at a mean of 36 months (24 to 89) after operation. The mean American Orthopaedic Foot and Ankle Society midfoot score was 81.4 (62 to 100) after primary treatment and 71.8 (35 to 88) after corrective arthrodesis (t-test; p = 0.031). We conclude that primary treatment by open reduction and internal fixation of tarsometatarsal fracture-dislocations leads to improved functional results, earlier return to work and greater patient satisfaction than secondary corrective arthrodesis, which remains a useful salvage procedure providing significant relief of pain and improvement in function.     

Treatment outcomes of unstable proximal phalangeal head fractures of the finger in children

The authors reviewed 37 children presenting with closed, unstable fractures of the proximal phalangeal head. Fractures were classified as intra-articular (n = 15), including 14 unicondylar and 1 bicondylar, or extra-articular (n = 22), including 20 subcondylar and 2 comminuted subcondylar. Eighteen patients underwent closed reduction with K-wire fixation (n = 11) or dynamic skeletal traction (n = 7). Nineteen patients underwent open reduction with K-wire fixation (n = 14) or miniscrews (n = 5). Results were considered excellent when the active range of motion (ROM) of the proximal interphalangeal joint was > or = 90 degrees (n = 26); fair, active ROM, 70 to 89 degrees (n = 6); and poor, active ROM < 70 degrees (n = 5). The intra-articular fractures were rated 9 excellent, 5 fair, and 1 poor. The extra-articular fractures were rated 17 excellent, 1 fair, and 4 poor. The 18 closed reductions, K-wire fixation (n = 11) and traction (n = 7), were rated 16 excellent and 2 fair. The 19 open reductions, K-wire fixation (n = 14) and miniscrew fixation (n = 5), were rated 10 excellent, 4 fair, and 5 poor. Closed reduction showed better results than open reduction. Dynamic skeletal traction proved to be simple and effective in treating these injuries.     

Closed reduction and percutaneous K-wires versus open reduction and interosseous loop wires for displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers in industrial workers

Seventy-eight male industrial workers with displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers were divided into two groups: Group 1 (n = 40 men, mean age = 34 years, range = 22-46 years) was treated with closed reduction and percutaneous K-wires, and Group 2 (n = 38 men, mean age = 33 years, range = 20-48 years) was treated with open reduction and interosseous loop wire fixation. At final follow-up, the total active motion (TAM) score of the injured finger was graded as excellent, good, fair or poor if it was greater than 240 degrees , 220 degrees , 180 degrees or less than 180 degrees , respectively. Group 2 had significantly better overall TAM scores than Group 1 (P = 0.03). The complication rate was higher in Group 1 than Group 2 (28% versus 11%) but the difference did not reach statistical significance (P = 0.084). The results were compared with those reported by other authors and other techniques of fixation of these fractures.     

儿童创伤性髋关节脱位的临床特点与治疗

目的 探讨儿童创伤性髋关节脱位的临床特点及治疗结果.方法 1990年1月至2006年12月收治的资料完整、随访超过2年的儿童创伤性髋关节脱位患者27例,男19例,女8例;年龄2.5～14.4岁,平均10.2岁.16例为高能量损伤,患者年龄(11.58±2.10)岁;11例为日常活动中受伤,患者年龄(8.30±2.93)岁.25例为后脱位,2例伤后自行复位者脱位方向不明.1例合并双侧股骨干骨折者初诊时漏诊.24例于伤后1～9h复位,其余3例复位时间超过24 h.21例闭合复位,6例切开复位.切开术中发现关节内骨软骨块3例,盂羼损伤嵌顿2例,关节囊嵌顿1例.复位后均采用单髋"人"字石膏制动4～6周.结果 27例中10岁以下者占48%.男女比例为2.4:1,左右侧别无差异.高能世损伤与低能量损伤患者年龄差异有统计学意义(t=3.392,P=0.002).全部病例随访2.4～8.3年,平均3.6年.按照Thompson和Epstein评价标准:优24例,良2例,可1例.末次随访时4例发生股骨头坏死,3例残留股骨头膨大和扁平髋.发生股骨头坏死者均为高能量损伤.延时≥24h复位组与<24h复位组股骨头坏死率的差异有统计学意义(X2=19.406,P=0.001).结论 儿童创伤性髋关节脱位所需创伤能量小,合并损伤少,10岁以前多为低能量损伤.闭合复位成功率高,并发症少.闭合复位不能达到中心复位者,可行切开复位及探查修复.24h内获得中心复位、无股骨头骺缺血坏死者疗效满意.     

Treatment of congenital dislocation of the hip--follow-up study of cases of bilateral dislocation of the hip

The treatment of congenital dislocation of the hip in 16 patients (32 hips) older than 9 years of age at the time of this follow-up study was evaluated. Most of the patients were treated at the age between 1 and 3 years. Right and left hips treated by different methods, either conservative treatment, Colonna capsular arthroplasty or open reduction, were examined radiologically and compared. Consistent results were not obtained in the patients who underwent conservative treatment or Colonna capsular arthroplasty. Among the patients of open reduction, better results were obtained in those of "open reduction with total capsulotomy" than those treated by other methods. The patients who underwent such an operation at an earlier age showed the best results. The results of open reduction were not inferior to those of conservative treatment if concentric improvement was observed immediately after the operation. Therefore, a treatment appropriate for each patient should be selected and conservative treatment alone should not be insisted upon.     

Long-term functional outcomes following paediatric traumatic elbow dislocation,a clinical retrospective cohort study

BackgroundPaediatric traumatic elbow dislocation occurs in 6 per 100,000 children per year and if not treated promptly can result in a poor outcome. Despite this, the long-term clinical and functional outcome of these injuries has not been well described using modern patient-reported outcome tools. The aim of our study was present the outcome of these injuries in the long term.MethodsTwenty children with an acute traumatic elbow dislocation who presented between February 2007 to February 2016 were included in our study. Patient demographics, management and complications were recorded from the clinical notes. Ten children had associated fractures and were managed surgically, while the remaining were managed with closed reduction and immobilisation. Functional outcomes were assessed with Kim's elbow performance score.ResultsThe mean age was 12 years (7 –15) and follow-up was 8 years (4 – 13). There was one (5%) re-dislocation requiring surgery and one (5%) ulna nerve neurapraxia that resolved within one month. The average Kim's scores were 87.5 (65 – 100) and 77.5 (60 – 100) in the closed reduction and open reduction groups, respectively (P=0.08). 80% (16/20) reported good or excellent outcome with a Kim's score of greater than 75 points with no cases of poor functional outcome reported in our series.ConclusionsTraumatic elbow dislocations in children, with or without associated fracture, have a good long-term functional outcome with appropriate early management.     

Treatment of physeal fractures in children]

The aim of the study was to determine final clinical and radiological results of epiphyseal fractures treated in our hospital. Thirty-five patients were included in the study (6 girls and 29 boys) aged from 5 to 17 years (mean 12.1 years). Follow up ranged from 2 to 20 years. According to Salter and Harris classification system 15 patients had type I and 20 had type II fracture. According to the Neer-Horowitz classification system of the proximal end of humerus one patient had grade III and three had grade IV fracture. Physeal fractures included: proximal end of humerus (n = 4), distal end of radius (n = 16) (with coexistent distal end of ulna fractures in 6 cases), distal end of femur (n = 4), distal end of tibia (n = 3) and distal end fibula (n = 8). Six patients were treated with open reduction and K-wire fixation, three with skeletal traction and cast, one with closed reduction and K-wire fixation and twenty five with closed reduction and cast. Neurovascular deficit was noted in any of our patients at admission and after reduction. During follow-up we did not notice physeal arrest, changes in limbs axis or limb shortening in any of our patients. All our patients had good clinical results. In 2 cases in early postoperative follow-up limitation of shoulder abduction after physeal fracture of proximal humerus was observed. Restoration of proper anatomical conditions is conducive to restore function of growth plate. Kirschner wire fixation did not increase the risk of growth arrest. Physeal injuries at the end of growth did not cause limb axis changes.     

Traumatic dislocation of the hip

Of 125 patients with traumatic dislocation of the hips treated, 96 were reviewed retrospectively; 80 were males and 16 females with an age range from seven to 81 years (mean, 33.5 years). Motorcycle accidents were the leading cause of traumatic dislocation in this series (40 cases, 42%). Associated injuries were found in 68 cases (70.8%). Seventy-seven hips (80%) were reduced within 24 hours. In follow-up periods ranging from 15 months to 18 years (mean, 7.5 years), 56 patients had excellent or good results (58.3%). Statistical analysis of the clinical results showed that those patients with simple dislocations had better functional recovery. The earlier the reduction, the better the results. Associated injuries affected prognoses. Good results were obtained in patients with early, stable, and accurate reductions by either closed or open methods.     

Laparoscopic Vertical Banded Gastroplasty - an Effective Long-Term Therapy for Morbidly Obese Patients?

Background:Vertical banded gastroplasty (VBG) has previously been documented as an effective treatment for morbid obesity.We have described a laparoscopic technique to perform this operation. Followup data are now presented. Methods: A consecutive series of 139 morbidly obese patients were operated on with laparoscopic VBG. The patients were assessed with respect to peri- and postoperative morbidity, postoperative recovery and weight reduction up to 5 years thereafter. Results: Conversions to an open operation (n=6) and early reoperations (n=3) occurred in the early part of the series. Late complications were observed in 8 patients. The average weight reduction after 1 year was 50% of excess body weight, which remained also after 2 years.The continued follow-up covering 3 to 5 years postoperatively revealed a moderate weight gain in about 20% of patients. Conclusion: VBG can be safely performed by use of the laparoscopic technique. The average weight reduction after 1 and 2 years was 50% of excess body weight, whereafter tendency to partial weight gain was noted, suggesting an outcome comparable to that documented after the open surgical approach.     

Short and midterm results with minimally invasive endovascular repair of acute and chronic thoracic aortic pathology

OBJECTIVES: Endovascular management of both acute and chronic thoracic aortic pathology has emerged as an alternative to open surgery. We reviewed our single center experience with endovascular devices for the treatment of thoracic aortic pathology. METHODS: Between April 2000 and October 2007, 116 thoracic aortic stent grafts were placed to treat a variety of acute or chronic thoracic aortic lesions. Thirty-five percent of the cases were performed emergently. Sixty-five percent of the patients were male; the average age was 63.9 years (range 20-93 years). Indications for treatment were chronic degenerative aneurysms (n = 70), traumatic aortic disruption (n = 20), complicated dissection, intramural hematoma, or penetrating aortic ulcer (n = 14), pseudoaneurysm (n = 10), and Diverticulum of Kommerell (n = 2). Arch vessel revascularization (n = 32) or mesenteric debranching (n = 7) was performed in select cases. Devices used were industry-approved thoracic aortic devices (n = 80), aortic cuff extenders (n = 19), or custom made by the surgeon (n = 17). RESULTS: The 30-day death, stroke and paraplegia/paresis rates were 5.2%, 8.6%, and 2.6%, respectively. Arterial access complications requiring immediate operative repair occurred at a rate of 11.2% (n = 13). The endoleak rate requiring repeat intervention was 6.9% (n = 8). The delayed graft infection rate was 5.2% (n = 6), with four of these cases resulting in death. The mean follow-up is 15 months (range 1-78 months). Computed tomography angiograms were performed at 1, 6, and 12 months following the index procedure, and yearly thereafter. CONCLUSIONS: Endovascular therapy for acute and chronic thoracic aortic pathology is a viable alternative to open surgery with comparable operative morbidity and mortality. Midterm results suggest that endografts are durable, but require more secondary interventions and imaging surveillance than open reconstruction.     

Laparoscopic Adjustable Gastric Banding versus Open Vertical Banded Gastroplasty: A Prospective Randomized Trial

Background: Laparoscopic adjustable gastric banding (LAGB) and open vertical banded gastroplasty (VBG) are treatment modalities for morbid obesity. However, few prospective randomized clinical trials (RCT) have been performed to compare both operations. Methods: 100 patients (50 per group) were included in the study. Postoperative outcomes included hospital length of stay (LOS), complications, percent excess weight loss (%EWL), BMI and reduction in total comorbidities. Follow-up in all patients was 2 years. Results: LOS was significantly shorter in the LAGB group. 3 LAGB were converted to open (1 to gastric bypass). Directly after VBG, 3 patients needed relaparotomies due to leakage, of which one (2%) died. After 2 years, 100% follow-up was achieved. BMI and %EWL were significantly decreased in both groups but significantly more in the VBG group compared to the LAGB group (31.0 kg/m² and 70.1% vs 34.6 and 54.9% respectively). Co-morbidities significantly decreased in both groups in time. 2 years after LAGB, 20 patients needed reoperation for pouch dilation/slippage (n=12), band leakage (n=2), band erosion (n=2) and access-port problems (n=4). In the VBG group, 18 patients needed revisional surgery due to staple-line disruption (n=15), narrow outlet (n=2) or insufficient weight loss (n=1). Furthermore, 8 VBG patients developed an incisional hernia. Conclusion: This RCT demonstrates that, despite the initial better weight loss in the VBG group, based on complication rates and clinical outcome, LAGB is preferred. It had a shorter LOS and less postoperative morbidity.     

Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study

OBJECTIVE: Traumatic dislocation and fracture-dislocation of the hip is an absolute orthopedic emergency that is steadily increasing in incidence. Early recognition and prompt, stable reduction is the essence of successful management. A delay in recognition and reduction leads to preventable complications and morbidity. The purpose of this retrospective study is to identify prognostic factors that predict long-term outcome after hip dislocation. METHODS: Between 1980 and 1994, 107 patients with traumatic dislocation of the hips were treated, and 62 are reviewed in this study. There were 57 posterior fracture-dislocations and 5 anterior-obturator dislocations. All of the patients' charts were reviewed. The physical examinations and radiologic controls of the patients who were called for last follow-up examination were performed by the first two authors (V.S. and E.K.). Anterior and posterior fracture-dislocations were classified according to the classification system developed by Steward and Milford and femoral head fractures were classified according to the Pipkin classification. All of the hips were classified as very good, good, medium, fair, and poor according to the functional evaluation system described by Merle d'Aubigne. Statistical analysis of the results was performed. RESULTS: There were 47 male patients and 15 female patients, with ages ranging from 14 to 72 years (mean, 34.5 years). Traffic accidents constituted the leading cause of traumatic dislocation in this series (52 cases [83.9%]). Associated injuries were found in 44 cases (71%). Fifty patients were treated with closed reduction, and 12 patients were treated with open reduction. Thirty-five hips (56.5%) were reduced within 12 hours. Full weight-bearing was resumed between 2 and 10 weeks (average, 8 weeks) after injury. In follow-up periods ranging from 3.6 years to 18.4 years (mean, 9.6 years), 44 patients (71%) had very good or good to medium results. Ten patients (16.1%) developed late posttraumatic osteoarthritis of the hip, and 5 patients (9.6%) developed osteonecrosis of the femoral head. In this study, it is found that the time between injury and reduction and the associated injuries are the most important factors in long-term prognosis. CONCLUSION: We believe that good results were obtained in patients with early, stable, and accurate reductions by either closed or open methods. Concentric reduction absolutely should be confirmed by radiographs of the pelvis and, if necessary, by computed tomographic scan. The routine use of seat belts could have prevented many of these injuries.     

Open surgical and endovascular treatment of superior vena cava syndrome caused by nonmalignant disease

OBJECTIVES: The purpose of this study was to evaluate the role of endovascular and open surgical reconstructions in patients with superior vena cava (SVC) syndrome caused by nonmalignant disease. METHODS: Clinical data from 32 consecutive patients who underwent endovascular or open surgical reconstruction of central veins because of symptomatic benign SVC syndrome between November 1983 and June 2001 were retrospectively reviewed. RESULTS: The study included 17 male and 15 female patients (mean age, 38 years; range, 5-69 years). Presenting symptoms were head fullness (n = 26), dyspnea or orthopnea (n = 23), headache (n = 17), or dizziness (n = 11); physical signs were head swelling (n = 31), chest wall collateral vessels (n = 29), facial cyanosis (n = 18), or arm swelling (n = 17). Etiologic factors included mediastinal fibrosis (n = 19), indwelling catheter (n = 8), idiopathic thrombosis (n = 4), or post-surgery (n = 1). Two patients were heterozygous for factor V Leiden; 1 patient had antithrombin III deficiency. Twenty-nine patients underwent surgical reconstruction with 31 bypass grafts: spiral saphenous vein (n = 20), superficial femoral vein (n = 4), human allograft (n = 1), or expanded polytetrafluoroethylene (ePTFE, n = 6). Eleven patients underwent percutaneous transluminal angioplasty or stenting; 3 primary and 8 secondary endovascular procedures were performed to treat graft stenosis (n = 7) or occlusion (n = 1). There were no early deaths. Five early graft failures in 3 ePTFE grafts and 2 bifurcated vein grafts (thrombosis, n = 4; stenosis, n = 1) were successfully treated with open surgical revision. Over a mean follow-up of 5.6 years (range, 0.4-16.6 years) in surgical patients, 17 additional secondary interventions were performed in 8 patients, 14 endovascular and 3 surgical. Primary, assisted primary, and secondary patency rates of surgical bypass grafts were 63%, 79%, and 85%, respectively, at 1 year, and 53%, 68%, and 80%, respectively, at 5 years. Graft patency was significantly higher in vein grafts compared with ePTFE grafts (P =.02). Mean follow-up after percutaneous transluminal angioplasty or stenting was 3.1 years (range, 1 day-11.7 years). Twelve secondary endovascular interventions were performed in 6 patients (primary group, 3 of 3; secondary group, 3 of 9 grafts in 8 patients) to maintain patency in 11 of 12 reconstructions. Mean follow-up in the entire patient cohort was 5.3 years (range, 0.4-16.6 years). In 79% of patients symptoms had resolved or were significantly improved at last follow-up. CONCLUSIONS: Surgical treatment of benign SVC syndrome is effective over the long term, with secondary endovascular interventions to maintain graft patency. Straight spiral saphenous vein graft remains the conduit of choice for surgical reconstruction, with results superior to those with bifurcated vein and ePTFE. Endovascular treatment is effective over the short term, with frequent need for repeat interventions. It does not adversely affect future open surgical reconstruction and may prove to be a reasonable primary intervention in selected patients. Patients who are not suitable for or who fail endovascular intervention merit open surgical reconstruction.     

应用不同手术方法治疗陈旧性肩锁关节脱位的疗效分析

目的比较分析应用不同手术方法治疗陈旧性肩锁关节脱位的疗效。方法对 43例陈旧性肩锁关节脱位患者分别应用单纯切开复位克氏针内固定 (9例 );切开复位内固定并肩锁关节韧带重建 (14例 );切开复位内固定并喙突上移 (20例 )三种手术方法进行治疗,术后平均随访 4.8年,对其自觉症状、上肢肌力、肩关节功能和肩锁关节间隙等改善程度进行比较。结果三种术式的优良率分别为 33％ (3/9)、 50％ (7/14)和 74％ (15/20)。单纯切开复位克氏针内固定法的疗效与切开复位内固定并肩锁韧带重建法相比,差异无显著性意义 (P >0.05),两者与切开复位内固定并喙突上移法比较,差异有显著性意义 (均 P< 0.05)。结论治疗陈旧性肩锁关节脱位的手术方法应达到 :(1)清除关节内瘢痕组织及软骨碎片; (2)重建关节纵向与水平稳定性; (3)施以有效内固定直至韧带修复,牢固愈合。     

The surgical treatment of teratologic dislocation of the hip

Since 1974, our approach to treatment of teratologic dislocation of the hip in children has been surgical. We retrospectively reviewed 20 teratologic hip dislocations in 13 children with a minimum follow-up of 2 years. Closed treatment failed in most of the hips. At a mean age of 13 months, 11 patients (18 hips) had an open reduction and a one-and-a-half hip spica. It was followed in most of these hips by a femoral varus derotational osteotomy 6 weeks later. Only three hips had an open reduction followed by 3 months of casting. One of these three hips had salmonella infection and a redislocation. Our main complication was avascular necrosis in 20% of hips, two patients (two hips) ending with a leg length discrepancy. There was some limitation of motion in 65% of hips but 76% of patients had a good functional hip score. There was no difference in the results of unilateral versus bilateral dislocation. Poor results were found in three patients and could be explained by trunk hypotonia, marked limitation of motion and severe involvement of upper extremities, multiple deformities and fixed flexion in the lower extremities, generalized weakness and developmental delay. In spite of these difficulties and complications, results are encouraging.     

Weight Reduction after an Early Version of the Open Gastric Bypass for Morbid Obesity: Results after 23 Years

Background: While numerous promising short-term results of open gastric bypass for morbid obesity were published, the long-term outcome of earlier versions was somewhat disappointing. Thus, it was not until 1993 that this procedure was reintroduced with current modifications and now performed laparoscopically. Published long-term results of gastric bypass are still lacking. Methods: Out of an original population of 195 patients, we retrospectively analyzed the outcome of 98 patients (82 women, 16 men, mean age 32 years [range 17-54], mean weight 132 kg [range 65-200], mean BMI 46.6 kg/m²) operated on in Erlangen with mean follow-up 22.9 years (range 16.5-25.4). 3 different bariatric operations were performed: horizontal gastroplasty (HGP, n=18), stapled Roux-en-Y gastric bypass (S-RYGBP, n=14) and transected Roux-en-Y gastric bypass (T-RYGBP, n=66). BMI and percentage of excess weight loss (%EWL) were calculated at time 0, and after 1, 2, 3, 10, 15, 20 and 25 years. Results: Statistically significant weight loss was found for the whole patient population at every postoperative time-point compared to preoperative values. Maximal weight loss was achieved mainly during the first 3 years. However, initial and long-term outcome after HGP was significantly worse than after S-RYGBP or T-RYGBP. Gender did not significantly influence the results. Conclusion: Traditional open gastric bypass resulted in acceptable and safe long-term weight reduction. It may be assumed that laparoscopic gastric bypass with modern tiny pouch volumes based on the lesser curvature achieves even better and life-long weight reduction.     

Initial results of the evaluation study of ultrasound hip screening in Germany

AIM OF STUDY: To assess the effectiveness of a universal sonographic screening of developmental dysplasia of the hip (DDH) established in Germany since 1996. METHODS: Currently a national survey is being performed in Germany to identify infants and young children who receive inpatient treatment for DDH. Between May, 1997 and October, 1997 monthly questionnaires were sent to all pediatric orthopaedic surgeons (active surveillance) and they were asked to report all inpatient cases between 10 weeks of age and 5 years with current closed or open reduction and/or osteotomies due to DDH. Information on time and results of previous ultrasound screening as well as treatment modalities was obtained in reported cases. RESULTS: 129 children (mean age at hospital admission 15.9 months, range 1.1 to 57.1 months) underwent closed reduction (n = 51), open reduction (n = 40) and osteotomies of the hip (n = 38) in the 6-month study period. Ultrasound screening has been performed too late and not at all in 45 children (35.1%). While in 18 cases (13.7%) no information could be obtained on screening results, the majority of children (n = 66, 51.2%) had completed DDH screening prior to the sixth week of life as recommended. Preliminary calculation of the unadjusted incidence of inpatient treatment for DDH in Germany was 0.33 per 1000 livebirths. CONCLUSION: DDH cases are still identified after introduction of an universal ultrasound hip screening in Germany. Continued evaluation must show, whether the incidence will decrease throughout the next few years.