Arthroskopisch unterstützte Frakturversorgung am Handgelenk

Distal radius fractures are the most common fractures in humans and early surgical intervention with modern plating systems is becoming increasingly more established to avoid secondary dislocation. Even fractures with slight dislocations are adequately stabilized and the affinity for surgical intervention and plating procedures is applied to secure these simple fractures. In this aspect the surgical indications are significantly dependent on X-ray examination results. Further diagnostics with respect to ligamentous and soft tissue injury are the exception although the impact energy which creates osseus fractures is sufficient by far to destroy functional soft tissue, cartilage and ligaments. The ongoing development of wrist arthroscopy enables new possibilities especially concerning concomitant articular involvement of distal radius fractures. Arthroscopy-assisted reduction and stabilization as well as minimally invasive soft tissue repair and loose body removal seem to be adequate methods to improve the surgical treatment of distal radius fractures.     

Die arthroskopisch unterstützte transkapsuläre Refixation des Discus triangularis am Handgelenk

Objective

Refixation of the triangular fibrocartilage complex (TFCC) to the ulnar capsule of the wrist.

Indications

Distal TFCC tears without instability, proximal TFCC intact. Loose ulnar TFCC attachment without tear or instability.

Contraindications

Peripheral TFCC tears with instability of the distal radioulnar joint (DRUJ). Complex or proximal tears of the TFCC. Isolated, central degenerative tears without healing potential.

Surgical technique

Arthroscopically guided, minimally invasive suture of the TFCC to the base of the sixth extensor compartment.

Postoperative management

Above elbow plaster splint, 70° flexion of the elbow joint, 45° supination for 6 weeks. Skin suture removal after 2 weeks. No physiotherapy to extend pronation and supination during the first 3 months.

Results

In an ongoing long-term study, 7 of 31 patients who underwent transcapsular refixation of the TFCC between 1 January 2003 and 31 December 2010 were evaluated after an average follow-up interval of 116 ± 34 months (range 68–152 months). All patients demonstrated an almost nearly unrestricted range of wrist motion and grip strength compared to the unaffected side. All distal radioulnar joints were stable. On the visual analogue scale (VAS 0–10), pain at rest was 1 ± 1 (range 0–2) and pain during exercise 2 ± 2 (range 0–5); the DASH score averaged 10 ± 14 points (range 0–39 points). All patients were satisfied. The modified Mayo wrist score showed four excellent, two good, and one fair result. These results correspond to the results of other series.

Conclusion

Transcapsular refixation is a reliable, technically simple procedure in cases with ulnar-sided TFCC tears without instability leading to good results.

     

Die Praxis der Blutübertragung

Ohne Zusammenfassung     

Die Dünndarmfaltung nach Noble

Ohne Zusammenfassung     

Erfahrungen mit Kraftübertragungsapparaten bei Lähmungen,Schlottergelenken und Gelenkdefekten

Ohne Zusammenfassung Mit 13 Abbildungen im Text.     

Die intermittierende Impulskompression zur Abschwellung und Thromboseprophylaxe – Pilotstudie nach Hüft-TEP

BACKGROUND: The use of intermittent compression devices for thrombosis prophylaxis and the reduction of postoperative swelling are widely accepted. The recommended minimum application of 2 h daily has never been statistically verified. Without evidence based data, the benefit of this costly equipment cannot be maximized. PATIENTS AND METHODS: A randomized clinical trial on 41 patients after total hip replacement was performed. The A-V Impulse System was applied for 2 h a day during the first 5 postoperative days to observe whether this time was sufficiently effective. RESULTS: In the control group, two deep vein thromboses occurred postoperatively, but there were none in the treatment group. Even though two patients from the treatment group had to be excluded from the study because of severe pain, all other parameters including visual analogue pain scale results and limb circumferences were comparable in both groups. CONCLUSION: These preliminary results suggest that pump systems can prevent deep venous thrombosis after hip surgery even when applied for only short intervals over a short period of time. However, large scale confirmatory studies are needed.     

Standardschnittebenen am Stütz- und Bewegungsorgan

Comparable to the standardized ultrasound screening of newborns and infants according to Graf's method, the standardized ultrasound examination of the locomotor apparatus has become an important feature in the evaluation of many acute and chronic diseases. The standardized ultrasound examination technique according to the guidelines of DEGUM and DGOOC helps the experienced and inexperienced user to avoid diagnostic mistakes by reproducibly displaying anatomical landmarks. Specific individual planes can be necessary in certain indications. The main advantage in comparison to other diagnostic means (i.e., computed tomography and magnetic resonance imaging) lies in the possibility of dynamic examination, which allows excellent imaging especially in rotator cuff affections. In cases without pathological findings, two standardized planes have to be documented. Otherwise, the pathological finding has to be documented in two standardized planes. The standardized procedure is a useful means for assuring and improving the quality of sonographic examinations of articular and periarticular structures.     

Die geriatrische Frührehabilitation nach hüftgelenknahem Oberschenkelbruch

Background

Modern strategies for postoperative care of patients with hip fractures include early discharge from the acute care hospital to inpatient interdisciplinary rehabilitation facilities. Whether these programs are effective for the patients and improve their long-term outcomes or if they simply transfer costs, with a reduction of the inpatient days in the acute care hospital, is currently under discussion.

Patients and methods

This prospective study included 282 patients with hip fracture admitted to our trauma center were included into the prospective study. The mean patient age was 86±8 (65–110) years. All patients were treated operatively. After a mean of 12±9 days, the patients underwent inpatient interdisciplinary geriatric rehabilitation for a mean of 27±13 (4–103) days. The primary outcome measure was their activities of daily living (Barthel index) before, at the end of rehabilitation, and 1 year after trauma. In addition, patient-related variables were correlated with the Barthel index.

Results

With discharge from the acute care hospital, the Barthel index was 42±20 points and it increased during rehabilitation to 65±26 points. One year later the Barthel index was 67±28 points. Ninety percent of patients improved their Barthel index during rehabilitation. Within 1 year, 40% of patients deteriorated in their activities of daily living. Fifty one percent of patients were reintegrated back to their homes. Patients who lived at home before trauma and were reintegrated back to their homes had a significant higher Barthel index (75±24) 1 year after trauma than patients who were living in a nursing care facility before the trauma (Barthel index 52±27). The variables of age, level of cognition, and type of fracture had no influence on the long-term outcome. An extension of rehabilitation above the mean time period did not improve the sustainable clinical outcome.

Conclusion

Postoperative inpatient rehabilitation programs enhance short-term activities of daily living. In particular, patients who lived at home before the trauma and were reintegrated back home benefited in perpetuity from geriatric rehabilitation. A policy for early discharge to geriatric rehabilitation is associated with extension of overall hospital stay. This association along with the related increased health care costs should be weighed against the sociofunctional effectiveness of these programs.     

Die Verhütung der Rezidive nach Krebsbehandlung

Ohne Zusammenfassung     

Stimm- und Sprachübungen nach Kehlkopfausrottung

Ohne Zusammenfassung     

Die Gesetze der entzündlichen Gelenkskontraktur,erläutert am Hüftgelenke

Ohne Zusammenfassung     

Krüppelfürsorge und krüppelanstalten nach ihrem

Ohne Zusammenfassung     

Korrekturosteotomien am Rück- und Mittfuß

Subtle osteotomy in the sense of disconnecting old fracture surfaces of a malunited or nonunited talus is sometimes suitable to restore secondary anatomic joint congruency of the ankle and subtalar joint, sometimes also of the talonavicular joint. Anatomic reconstruction of the posterior facet of the calcaneus can seldom be achieved. Closing or opening wedge osteotomies and shifting or rotatory osteotomies of the calcaneus and the navicular or cuneiform bones are suitable at least to correct varus or valgus deformities and abduction or adduction malpositions. Sometimes a shortening osteotomy of the cuboid can balance the lengths of the lateral and medial column. Large and small screws as well as an interlocking plate with a minimal size of 2.0 mm guarantee safe healing of the corrected tarsal or metatarsal bone. By anatomic secondary joint reconstruction, corrections of all axes and lengths and ensuring bone stability, post-traumatic arthritis can be prevented or its development delayed.     

Willkürliche Schulterluxation nach vorne,rückwärts und unten

Zusammenfassung Es wird über einen Fall von willkürlicher Schulterluxation nach vorne, unten und rückwärts berichtet sowie über den Versuch, diesen Zustand, soweit er den Patienten behinderte, operativ zu beseitigen.Mit 2 Textabbildungen (5 Einzelbilder)Herrn Professor Dr. Ph. Erlacher zum 75. Geburtstag gewidmet.