Die Behandlung intraartikulärer Fersenbeinfrakturen mit einem gelenkübergreifenden Fixateur externe

Operative treatment of the calcaneus is still in discussion. For a better management of soft tissue problems an optimized fixator frame for primary treatment of calcaneus fractures was developed in the Dept. of trauma surgery University of Kiel. A one-plane bilateral construction with one insertion point in the tibia and two in the tuberosity of calcaneus is used. It allows efficient reduction by ligamentotaxis, stable fixation and active motion in ankle joint. We treated 40 patients with 45 calcaneus fractures. In 25 cases the fixator was definite and later plate or screw fixation was performed 20 times. 35 patients with 40 fractures were examined by means of the "Kiel score for calcaneus fractures". Patients who were treated definite reached better longterm-results on average than patients who underwent a secondary open osteosynthesis. Concrete guidelines for the therapy of intraarticular calcaneus fractures are presented.     

Nicht gelenküberbrückender Fixateur externe vs. palmare winkelstabile Plattenosteosynthese in der Behandlung der distalen extraartikulären Radiusfraktur

Aim/Purpose

The aim of operative treatment of distal radius fractures is to achieve anatomic restoration and stable fixation allowing early wrist movement. The extraarticular radio-radial fixator may provide both. In a prospective randomized trial, the nonbridging external fixator was compared with open reduction and internal fixation by volar fixed angle plating.

Methods

A total of 62 patients with extraarticular fractures of the distal radius were included in a prospective randomized trial: 33 patients were treated by external fixation and 29 patients by internal plate fixation. Follow-up examinations were carried out 8 weeks, 6 months, and 1 year after surgery.

Results

The time for surgery using the nonbridging external fixator was significantly less (41 minutes) than using volar plating (56 minutes), whereas intraoperative fluoroscopy time turned out to be twice as long (2 minutes). The functional outcome was good or excellent in both treatment groups. Eight weeks after surgery, patients with nonbridging external fixation presented with significantly less grip strength (26% of the contralateral hand) compared to patients with volar plating (48% of the contralateral hand). The restoration of the physiological volar tilt was achieved more precisely by external fixation. The results of the SF-36 health survey did not show any significant differences between both groups.

Conclusion

Nonbridging external fixation is a good alternative treatment option to open reduction and volar plating. The minimally invasive technique allows for anatomical restoration and safe reduction permitting early range of motion. The clinical and radiological results are good to excellent accompanied by a low rate of complications.     

Die Behandlung instabiler distaler Radiusfrakturen mit einem transarticulären Fixateur externe Ergebnisse einer Langzeitbeobachtung

INTRODUCTION: The aim of our study was to evaluate external fixation in the treatment of unstable distal radius fractures in a long-term follow-up. METHODS: Within 8 years 174 patients with severely displaced distal radius fractures were included in a prospective study and treated with an external wrist fixator (Orthofix Srl, Italy). A total of 148 patients were reviewed with an average follow-up time of 28 months. RESULTS: Using the functional outcome score according to Gartland and Werley, we obtained 29.3 % excellent, 42.5 % good, 10.3 % fair and 2.9 % poor results; 14.9 % of the patients were not available for follow-up. Additional procedures were carried out in 54.1 % to obtain dorsal stabilization. The list of complications included two major pin-tract infections requiring surgical intervention, one pin cut out of the second metacarpal bone, one fixator dislocation, and one patient had algodystrophy. The length of the radius and joint congruity did not significantly from the situation when the fixator has been removed at the end of the treatment. CONCLUSION: The results show the importance of anatomical reduction, and especially restoration of radial length, in order to obtain good functional outcome.     

Die Behandlung mit der künstlichen Niere

Langenbeck's Archives of Surgery -     

Die Behandlung der Gelenkentzündungen mit Auswaschungen und Injectionen

Ohne Zusammenfassung     

Die Überbrückung von posttraumatischen Knochendefekten

Bony defects as a result of injury or disease can be caused by a variety of conditions such as acute injury, fall fractures in osteoporotic patients or tumours and congenital malformations of the musculoskeletal system which necessitate the resection of affected parts of the bone. This results in a multitude of defects concerning localisation and specificity as well as a number of conditions involving both hard and soft tissue structures and various situations of different patients. A reasonable classification of defects which is relevant for practical purposes includes four basic types: defects of the spine, metaphyseal defects as well as partial and complete diaphyseal defects of long bones. A variety of options exists for the treatment of these conditions. The aim of all efforts is to reinstall the integrity of affected structures long-lastingly and dependably and at the same time guarantee the normal function of joints involved. In addition to classical treatment strategies which involve the use of autogenous and allogenous corticocancellous bone grafts a great number of bone substitute materials can also be used. Further options lie in complex reconstructive methods such as the transport of whole segments or the transplantation of vascularised bone grafts. The field of new regenerative strategies including tissue engineering as well as stem cell and gene therapy holds great promise for the future. The aim of this review is to derive a ranking from the evaluation of biological and mechanical characteristics for the treatment of posttraumatic defects.     

Behandlungsergebnisse nach Primärversorgung erheblich dislozierter OSG-Luxationsfrakturen mit gelenkübergreifendem Fixateur externe und sekundärer interner Osteosynthese

Background

Between 1 January 2001 and 30 June 2003, 31 patients with dislocated ankle fractures were primarily treated with an external fixator in our clinic. The aim of the present study was to investigate whether such a concept would determine the overall outcome or influence single parameters such as mobility, dystrophy, pain, arthritis, and complications.

Methods

Of the 31 patients, 25 aged 18–84 years at the time of the accident were followed up for 6–23 months to assess range of motion, clinical scores, radiological findings, and complications. An isolated injury was present in 23 patients and 3 were open injuries of second to third degree. Between two and five operations were necessary 4–27 days after trauma. The duration of primary hospital care required ranged from 10 to 43 days.

Results

The Olerud and Molander score (9 criteria with 100 max points) was 80 points at the follow-up investigation (rated “good”). “Excellent” results (>90 points) were observed in four cases. In the range of motion there was only an average loss in plantar flexion of 12.4° compared to the healthy side in the patients followed up.

Conclusions

The treatment result in the study population was compared to the results of prospective studies investigating dislocated ankle joint fractures as well as with our own random sample (n=7) of patients with secondarily treated ankle joint fractures that were initially treated with a cast. Initial external fixation seems to be justified and leads to acceptable results. The main functional lesions are not correlated to the specific treatment selected.     

Die Überbrückung operativer Choledochusdefekte mittels Gummirohrs

Ohne Zusammenfassung     

Die Behandlung der Duodenal-Dünndarmfistel

Ohne Zusammenfassung Mit 4 Textabbildungen     

Die konservative Behandlung frischer Brüche der Eminentia intercondyloidea tibiae mit Verschiebung

Ohne ZusammenfassungMit 4 Textabbildungen.Herrn Professor Dr. Lorenz Böhler zum 70. Geburtstag gewidmet.     

Die ambulante Behandlung von Knochenbrüchen mit Gipsverbänden und Distraktionsklammern

Ohne Zusammenfassung (Mit 9 Abbildungen.) Auszugsweise vorgetragen am 4. Sitzungstage der 42. Versammlung der Deutschen Gesellschaft für Chirurgie zu Berlin, M?rz 1913, unter Demonstration von 3 Knochenbruchpatienten, bei welchen die Distraktionsklammern vor 8 Tagen angelegt waren.     

Die chirurgische Behandlung des Duodenalgeschwürs

Ohne Zusammenfassung     

Die Behandlung der medialen Epikondylusbrüche

Ohne Zusammenfassung Mit 4 Abbildungen auf Tafel I.     

Distale Radiusfraktur – Ist der nicht-gelenküberbrückende Fixateur externe eine therapeutische Alternative? Eine prospektiv randomisierte Studie

A randomised prospective study was carried out to compare non-bridging external fixation using a small A0 external fixator with percutaneous Kirschner wire fixation and plaster in the treatment of distal radial fractures (A2/A3 in the A0 classification). The study involved 40 patients, 20 in each group. The advantages of the non-bridging fixation are: (1) early functional therapy of the wrist, (2) simplified reduction of the fracture, and (3) considerable less restriction of wrist mobility in day-to-day situations. Although the final examination 6 months after treatment showed almost identical functional results, the patients treated with the external fixator benefited from the fact that use of the wrist was virtually free throughout the entire treatment period.