Zur Abhängigkeit der Valgusstellung der Ferse von der Stellung des oberen Sprunggelenkes

Zusammenfassung Auch bei arthrodesiertem unterem und vorderem Sprunggelenk wirkt sich eine Dorsalflexion des Fußes (Hackenfußstellung) auf die Ferse so aus, daß sie mehr Valgusstellung einnimmt. Bei Spitzfußstellung (Plantarflexion) vermindert sich die Valgusstellung. Für die Behandlung des kindlichen schlaffen Knickfußes soll man daher etwas höhere Absätze verordnen, als sie der übliche Ladenschuh hat. Für den korrigierten Klumpfuß, bei dem die Ferse wieder in Varusstellung zu gehen droht, verordnet man den absatzlosen Schuh oder sogar die Einbettung in leichter Hackenfußstellung.Mit 3 Textabbildungen (7 Einzelbilder)     

Klinische Ergebnisse nach Sauvé-Kapandji-Operation in Abhängigkeit der Erkrankung

We present the results of a retrospective study on 56 patients who underwent the Sauve-Kapandji procedure for chronic disorders of the distal radioulnar joint (DRUJ). Outcome was assessed with special regard to the diagnosis.The average follow-up was 5.9 years (1-12 years). Patients were assessed for pain, range of motion of wrist and forearm, and radiological features. The DASH score and Mayo wrist score were used.The diagnosis had an influence on the outcome. Patients with primary arthrosis of the DRUJ demonstrated better results than patients with traumatic disorders. Patients with growth deficiency-related complaint of the DRUJ showed slightly inferior results after the Sauve-Kapandji procedure compared to all patients. Patients were free of pain or had pain only during heavy labor in 81% of cases; 95% of the patients rated the outcome as excellent or improved, but only 50% were free of symptoms on the operated side during heavy manual labor. Symptoms of ulnar impingement were found in 11%. Improvement in range of motion of wrist and forearm was significant. The postoperative DASH score was 24.2+/-22.5 and the Mayo wrist score was 76.1+/-17.6.Our results confirm the Sauve-Kapandji procedure to be a reliable salvage procedure resulting in high patient satisfaction and reliable improvement in range of motion. However, decreased grip strength on the affected side must be accepted to some extent. The diagnosis of a DRUJ disorder influences the outcome.     

Erkrankungen des Netzes in Abhängigkeit von der Mechanik des Bauchraumes

Zusammenfassung Es wird über die möglichen Erkrankungen des Netzes, ihre Ätiologie, Pathogenese und Klinik berichtet. Besondere Bedeutung kommt der behinderten Mechanik des Bauchraumes bei der Entwicklung akuter Prozesse zu. Zwei eigene Beobachtungen unterstützen diese Behauptung, auf die seltene Erkennung des Krankheitsbildes wird hingewiesen.Herrn Prof. Dr.W. Block zum 70. Geburtstag.     

Untersuchungen über die spontane Gangrän der Extremitäten und ihre Abhängigkeit von Gefässerkrankungen

Ohne Zusammenfassung Aus der chirurg. Abtheilung des Hrn. Docent W. Zoege v. Manteuffel im Dorpater Bezirkshospital und aus seiner Privatpraxis (Mit 2 Abbildungen.) [Fortsetzung aus Bd. XXXIX.]     

Elektrische Nervenstimulation in Abhängigkeit von der benutzten Impulsbreite Eine quantitative Untersuchung zur Annäherung der Nadelspitze an den Nerven

In the present study the difference of the distances of the tip of the needle to the nerve at similar current intensities but different pulse widths (100 microseconds vs. 1000 microseconds) were determined by means of 20 blockades of the sciatic nerve using the transgluteal approach of Labat. Comparable current intensities at different pulse widths (100 microseconds vs. 1000 microseconds) were compared in the same way, using the same position of the needle. At a pulse width of 100 microseconds and a current intensity of 0.30 mA, the tip of the needle is on an average of 5.0 mm closer to the nerve than with a pulse width of 1000 microseconds and a comparable current intensity of 0.28 mA (difference statistically highly significant; p < 0.005). The comparison of the current intensities at different pulse widths at the same needle-position shows that the difference of the current intensities becomes lower when approaching the nerve. At the most distant point measured in this study, a current intensity of 0.94 mA at 100 microseconds corresponds to an aquivalent current of 0.30 mA at 1000 microseconds (difference 0.64 mA); after an approach of 5.0 mm to the sciatic nerve, this difference is significantly lower (0.30 mA at 100 microseconds, 0.11 mA at 1000 microseconds, difference 0.18 mA; p < 0.01). This means that the control of peripheral nerve stimulation is superior at a pulse width of 100 microseconds because a similar distance corresponds to a greater difference of the current. The success rate of the blockade was 95% at a current of 0.30 mA at 100 microseconds. Nerve lesions or other complications have not been seen. In conclusion, safe and successful nerve blocks in patients without polyneuropathia using the peripheral nerve stimulation seems to be obtained at a current intensity of about 0.30 mA at a pulse width of 100 microseconds.     

Frakturen der oberen Extremität bei gurtgeschützten PKW-Frontinsassen Verletzungsart und -häufigkeit in Abhängigkeit vom Unfallmechanismus

During 1985 and 1995, 3,260 restrained car drivers (1,228 front seat passengers) were injured in 9,380 crashes involving cars. 179 (5.5%) (front seat passengers: 53, 4.3%) of those sustained fractures, of the arm. Among the 384 single fractures the hand (25%), wrist (23%) and forearm (23%) were affected most often, elbow (9%), upper arm (10%) and shoulder (10%) rather seldom. Half of the evaluated fractures of the long tubular bones were type A-fractures due to the AO classification and the other two quarters, respectively type B- and C-injuries in each case. 16% were open fractures. No considerable differences of the injury mechanism were found comparing drivers and front seat passengers. Since over half of all fractures resulted from a direct impact to the hand and/or arm, modifications are necessary in order to improve the energy absorption by means of padding the dashboard and the inner door. The use of side- and front-airbags could serve as an additional auxiliary equipment, as long as it doesn't induce a supplemental stress, through unfolding of the airbag.     

Zur Frage der Entstehung der Spätchloroform-schäden

Ohne Zusammenfassung     

Interdisziplinäre Behandlung der Weichgewebesarkome der Extremitäten

Soft tissue sarcomas are a rare and heterogeneous group of tumors. Surgery clearly remains the standard therapy of non-metastatic soft tissue sarcoma. A pretreatment biopsy is necessary to determine the histology and grade of soft tissue sarcomas and to diagnose entities that can be treated by targeted therapies, such as dermatofibrosarcoma protuberans or alveolar soft tissue sarcoma once they are in a metastatic stage. Nevertheless, locally advanced disease requires multimodal treatment and interdisciplinary treatment decisions. Limb sarcoma of borderline resectability (encasement of vessels, invasion of joints or close proximity to motor nerves) may profit from isolated limb perfusion with recombinant tumor necrosis factor and melphalan. Preoperative chemotherapy may be applied in locally advanced high grade tumors when clear resection margins are difficult to achieve. Deep wave hyperthermia has proven to be a useful addition to systemic chemotherapy in such a neoadjuvant setting. Also preoperative radiation therapy has proven to be effective in controlling locally advanced sarcoma despite higher perioperative morbidity which pays off in the long run by better limb function. Postoperative adjuvant external beam irradiation therapy with the best available technique is recommended for any tumor larger than 5 cm with (FNLCC) grades 2 and 3 (American Joint Committee on Cancer stage IIb/III). Given all these therapeutic options, it is absolutely crucial that interdisciplinary decision-making starts early in the therapeutic process. Patients are often seen first by the surgeon. For an optimal treatment surgeons need to know the efficacy and toxicity of the multimodal treatment options described.     

Ruhigstellung der Halswirbelsäule in der Präklinik

Notfall + Rettungsmedizin - Um die Immobilisation möglicher Wirbelsäulenverletzungen im Rahmen der prähospitalen Versorgung wird seit Jahren eine kontroverse Diskussion geführt....     

Notärztliches Atemwegsmanagement in Abhängigkeit von Fachrichtung und Weiterbildung

Die Anaesthesiologie - Das Management des schwierigen Atemwegs ist eine präklinische Schlüsselqualifikation. Für Notärzte mit hohem Erfahrungsgrad im Atemwegsmanagement sind...     

Die Entwicklung der orthopädischen Versorgung der Kriegsbeschädigten

Ohne Zusammenfassung     

Zur Operation der Gynäkomastie und der Hängebrust

Ohne Zusammenfassung Mit 3 Abbildungen.     

Zur Begutachtung der Erkältung und der Erkältungskrankheiten

Ohne Zusammenfassung     

Pioniere der Extremitätenverlängerung

Successful lengthening of the extremities was first published at the beginning of the twentieth century. Those reports in which methods such as the distraction of fragments, callus or epiphysis were mentioned for the first time are reviewed. Lengthening of the extremities by epiphyseal distraction was first mentioned by Bernhard v. Langenbeck in 1869 in an animal experiment. The publications of Codivilla, who introduced lengthening by fragment distraction, Kirschner, Bier and others are cited and analyzed critically. Thus, the historical development of the lengthening of the extremities is reported from 1869 to the middle of the twentieth century.     

Zur Unterbindung der grossen Gefässstämme in der Continuität bei Erkrankungen und Verletzungen der unteren Extremitäten

Ohne Zusammenfassung Ein Erratum zu diesem Beitrag ist unter zu finden.