Verletzungen und Rekonstruktion des Streckapparates nach Knie-TEP

Extensor mechanism injuries in total knee arthroplasty include disruption of the quadriceps tendon, disruption of the patellar tendon, and/or patellar fractures. While these injuries are rare, they are a devastating complication to manage. This review summarizes the anatomy of the extensor mechanism, risk factors for extensor mechanism injuries, and the prevalence and diagnosis of extensor mechanism injuries. In addition, this review outlines non-operative and operative management options. A new surgical approach for the reconstruction and augmentation of the extensor mechanism with the use of a synthetic mesh is described in detail. In multiple publications and in our own experience this newly developed technique shows promising results.     

Begutachtung nach Verletzungen des Ellenbogengelenks

Injuries of the elbow region are frequently complex lesions associated with bony and soft tissue affections. Often soft tissue damage is crucial concerning clinical outcome. Functional deficits of that complex articulation disable the entire limb, causing especially instability and restricted range of motion. Standard degrees of disability concern arthrodesis and amputation and can be used as guidelines for different lesions. A special situation exists in condylar fractures in children, which require frequent controls because of the risk of deviation and the necessity for corrective osteotomy.     

77. Therapie und ErgebniBe nach frischen Verletzungen des Kniebandapparates

ZusammenfaBung Bandverletzungen, die eine Instabilität des Kniegelenkes bedingen würden, d. h. in der gehaltenen Aufnahme eine Seitendifferenz von > 3° aufweisen, behandeln wir operativ. Die Therapie besteht aus einer anatomischen Rekonstruktion von Kapsel, Bändern und Menisci. Postoperativ wird ein Bewegungsgips angelegt, der einen AuBchlag von 40° erlaubt und die Stabilität nicht gefährdet. Von 80 Fällen mit frischen Bandläsionen fand sich bei der SchluBkontrolle in über 90 % ein subjektiv gutes Ergebnis, 77 Patienten konnten durchschnittlich 5,3 Wochen nach Gipsabnahme ihre Arbeit wieder aufnehmen, die Beweglichkeit war zufriedenstellend, die Gelenke bei 69 voll stabil.     

Die Verletzungen des medialen Seitenbandes und des vorderen Kreuzbandes am Kniegelenk und ihre operativfunktionelle Behandlung nach Lemaire

The present paper reports the results of 112 extraarticular ligamento-plasties performed on the knee with the procedure proposed by Lemaire. The series includes isolated tears of the anterior cruciate and medial collateral ligament as well as combined tears of both ligaments. The clinical and radiological results with a mean follow-up time of 11.5 years are compared with the results obtained in a first assessment 8 years ago. Good clinical results are in contrast with increasing osteoarthrosis in 1/3 of the knees radiologically assessed. The operation for a torn anterior cruciate ligament should be performed as soon as possible to avoid secondary meniscal lesions with subsequent severe osteoarthrosis. Presence or absence of arthrotic signs in the X-rays mainly determine the long-term result after ligamento-plasties of the knee. The Lemaire plasties are well tolerated even by elderly still active people and need little postoperative care.     

Verletzungen des Nierenbeckens und des Ureters

About 5% of injuries of the urinary tract affect the renal pelvis and ureter and constitute a severe complication. Around 75% of these injuries are iatrogenic and only about 25% are caused by blunt abdominal trauma or perforation. To avoid complications and improve prognosis, immediate diagnosis and therapy are essential. The diagnostic accuracy of preoperative studies is low, therefore frequently injuries are detected during explorative laparotomy. The management of upper urinary tract lesions depends on severity and localization, whereas the ultimate ambition should always be the preservation of the kidney. As a basic rule, ureteral stenting is mostly sufficient for small lesions, and only larger injuries require open reconstructive techniques. Longitudinal studies document a high degree of functional reconstitution if adequate and immediate treatment is carried out.     

Verletzungen des unteren Harntrakts und des Urogenitalsystems

Injuries of the lower urinary tract occur in patients with multiple injuries and trauma to the lower abdominal and pelvic region. Injuries of the male urethra including complete ruptures occur in 10% of pelvic fractures in males, while they are a rarity in females. Ruptures of the urinary bladder are either intra- or extraperitoneal. Ureteral injuries are relatively rare in blunt injuries and usually become manifest with infectious symptoms with a delay of days. Intraperitoneal ruptures of the urinary bladder always require urgent surgical repair while extraperitoneal ruptures can mostly be managed conservatively with catheter drainage of the bladder. In male patients with pelvic fractures any attempt of urethral catheterization which can otherwise make an urethral injury worse should be withheld until adequate urological examinations have led to the diagnosis or exclusion of urethral injury. The definitive surgical repair of a disruption of the male urethra should be undertaken with an interval of weeks to months. Long term sequelae of male urethral injury can be impotence and chronic stricture disease.     

Verletzungen und Erkrankungen des Akromioklavikulargelenkes

Osteoarthritis or instability of the acromioclavicular (AC) joint may cause significant impairment or pain in the shoulder. If symptoms of osteoarthritis persist despite conservative treatment, distal clavicular resection is usually curative. Injuries and instability are classified according to Rockwood. Treatment of mild instability due to trauma is nonoperative. An underestimated acute injury to the AC joint may result in chronic instability. Different techniques are presented for operative treatment of significant acute or chronic instability. Arthroscopic methods are now available for treating both acute and chronic instability.     

Zuggurtung und Bandnaht bei Zerreißung des Akromioklavikulargelenks

Summary Goal of Surgery Reduction of dislocations of the AC joint and its maintenance by internal fixation. Indications Acute and chronic AC dislocations of Tossy type III in patients with high occupational and athletic demands. Lateral clavicular fractures and pseudarthroses. Contraindications Acute and chronic AC separations of Tossy type I and II. Local infections. Lack of patient's cooperation. Positioning and Anaesthesia Supine, beach chair position. General anaesthesia. Surgical Technique Open reduction of the AC joint, internal fixation with tension band wiring and suture of the torn ligament through a sabre cut incision. Postoperative Management Velpeau dressing until complete wound healing. Active mobilization to the level of the horizontal plane after wound healing. Implant removal after 6 to 8 weeks followed by complete range of motion exercises. Possible Complications Wire breakage. Inadequate reduction. Migration of wires. Redislocation. Posttraumatic osteoarthritis. Injury of subclavian artery or brachial plexus. Results 46 out of 57 patients had a normal postoperative course, in 4 an infection occurred. A loosening of the internal fixation was observed 6 times, 4 out of 57 patients could be followed-up at an average of 21.5 months. 40 patients had an excellent or good result, and 7 had a satisfactory or poor outcome. In 37 patients a normal range of motion was found.

     

Ergebnisse nach operativer Behandlung von Verletzungen des Kniebandapparates

Between 1971 and 1979 60 patients with fresh lesions of the knee joint ligaments were treated surgically in Gießen. 37 of these patients could be followed-up two years after the accident. Seven patients from 1979 were excluded due to the shortness of time. A scheme of evaluation with different criteria was established. In 17 patients — almost 50% — a good, in another 17 a satisfying result was achieved. In three cases, whose injuries and complications are described in detail, the outcome was poor.     

Verletzungen des Sattelgelenks und posttraumatische Rhizarthrose

Background

Precise function of the hand is crucially characterized by opposition movement of the thumb, only possible because of the functional anatomy of the first carpometacarpal joint. High functional demands to this joint consequently lead to the highest rate of osteoarthritis of the hand joints and loss of function. Carpometacarpal (CMC) osteoarthritis of the thumb is rarely seen in posttraumatic cases. It can be caused by fractures involving the joint surfaces of both, the trapezium or the first metacarpal, whereas dislocations of the carpometacarpal joint itself only occasionly lead to osteoarthritis.

Objectives

Identification and compilation of current concepts in diagnosis and therapy of posttraumatic carpometacarpal osteoarthritis of the thumb.

Methods

Selective PubMed and Cochrane review, data obtained from own patient investigations and author’s experiences were used.

Results

Adequate treatment of the injury will minimize the risk for future malfunction. In early stages, arthroscopy is a valuable method for the diagnosis and treatment of posttraumatic rhizarthrosis. For all stages, a multitude of operative procedures are described and being used but yet not finally assessed for effectiveness. Advanced osteoarthritis of the first CMC joint is widely treated by trapeziectomy, which is suitable for most patients, and considered as gold standard. Additional procedures like suspension, interposition or k-wire transfixation do not provide any significant advantage and lead to comparable results. It is advisable to treat hyperextension of the metacarpophalangeal joint of the thumb at any stage of CMC osteoarthritis.     

Verletzungen des Beckenrings und der Beckenorgane

The integration of multislice CT (MSCT) in the imaging of emergency trauma has led to a paradigm shift in trauma management. In case of hemodynamically instable patients, initial imaging is limited to a small set of standardized radiographs. Computed tomography is the imaging modality of choice for further diagnostic work-up. Consequently it should be used at an early stage and in a less restricted manner for complete assessment of the pelvic injury and to determine therapeutic management. The MSCT allows full assessment of bone, parenchymal, and vascular injuries in a single examination in the shortest time possible. High-resolution 3D imaging provides additional options. There is increasing support for primary use of MSCT in critically ill patients due to the comprehensive imaging it allows while maintaining a fast scan time. The potential and limitations of diagnostic imaging in pelvic ring fracture and associated injuries are explained. Indications for vascular interventions in arterial bleeding are discussed.     

Akute Sprengung des Akromioklavikulargelenks

Trauma und Berufskrankheit - Die Luxation des Akromioklavikulargelenks (AC-Gelenk) ist eine typische Sportverletzung. Je nach ihrer Ausprägung kommt es zu einer Schädigung der akromio-...     

Verletzungen des Larynx und der Trachea

Injuries of the larynx and trachea are rare events, but because of the localization they can have substantial consequences for the patient. An early diagnosis and securing of the airway are of utmost importance for survival of the patient. In this article the anatomy, pathomechanisms and the classification of injuries with the treatment options are reviewed.     

Akute Sprengung des Akromioklavikulargelenks

Dislocation of the acromioclavicular joint (AC joint) is a typical sports injury with rupture of the acromioclavicular and coracoclavicular ligaments which may result in a vertical and horizontal instability of the lateral clavicle. Stress X-rays may be of help for the diagnosis of vertical instability and for the diagnostics axial or Alexander views should be made. In the future magnetic resonance imaging (MRI) will play a significant role for the diagnostics of AC joint injuries. With this method injuries of ligaments, fascia and the glenohumeral joint can be diagnosed. There is controversy regarding the therapy of AC joint injuries. For slight injuries a conservative treatment is recommended, for medium degree instability there is too little evidence in the literature to give a clear recommendation whether conservative or operative treatment is superior and for severe instability an operative treatment is recommended. For operative treatment several techniques have been described. Some techniques have a high complication rate and implant removal is also disadvantageous. These disadvantages led to the development of minimally invasive or arthroscopic techniques. The first clinical results of these new techniques are encouraging.     

Arthroskopische Resektion des Akromioklavikulargelenks

Objective

Arthroscopic resection of the painful and degenerative altered acromioclavicular (AC) joint without destabilization of the joint and therefore pain relief and improvement in function.

Indications

Conservative failed therapy of painful AC joint osteoarthritis. Impingement caused by caudal AC joint osteophytes. Lateral clavicular osteolysis.

Contraindications

General contraindications (infection, local tumor, coagulation disorders), higher grade instability of the AC joint (resection only together with stabilization).

Surgical technique

Diagnostic glenohumeral arthroscopy. Treatment of accompanying lesions (subacromial impingement, rotator cuff, long head of biceps). Subacromial arthroscopy with bursectomy (partial) and visualization of the AC joint. Resection of caudal osteophytes. Localization of the anterior portal using a spinal needle in the outside-in technique. Resection of 2–3 mm of the acromial side and the 3–4 mm of the clavicular side with shaver/acromionizer.

Results

An isolated open AC joint resection was performed in 9 studies and an arthroscopic resection in 6 studies. Good and very good results were obtained in 79?% (range 54–100?%) in open resection and 91?% (range 85–100?%) in arthroscopic resections. Patients were able to return to activities of daily life more quickly after arthroscopic resections than after open surgery.