Kahnbeinfraktur — operative behandlung,indikationen, methodik,ergebnisse

In 95% der Fälle führt eine konservative Behandlung nach einer Kahnbeinfraktur zur knöchernen Konsolidierung. Eine primär operative Behandlung erscheint dann gerechtfertigt zu sein, wenn eine Instabilität durch Verdrehung bzw. Kippung oder Verschiebung der Fragmente sowie Begleitfrakturen desselben Armes bzw. eine de Quervainsche Luxationsfraktur vorliegen. Es werden die verschiedenen operativen Möglichkeiten beschrieben und anhand einer Sammelstudie die Komplikationen dargelegt. 14.5 % Komplikationen nach operativer Versorgung einer frischen Kahnbeinfraktur, worunter die Ausbildung einer Pseudarthrose zu verstehen ist, berechtigen somit nicht zu der Fragestellung: Konservative oder operative Behandlung des frischen Kahnbeinbruches?     

Die Endo-Exo-Femurprothese

Because of insufficient soft-tissue conditions and variability in the size and mechanical friction of the stump treatment of upper leg amputees with an ordinary prosthesis might be difficult or even impossible. Alternatively, for such patients an endo-exo femoral prosthesis (EEFP) is sometimes the best treatment option. The use of EEFPs will be demonstrated as exemplified by the clinical course in a patient with a primary EEFP implantation including all relevant side-effects and associated problems.     

Die Achillessehnenruptur

The rupture of the Achilles tendon is the most frequent tendon rupture in humans and it is associated with increasing incidence. The main risk factor is intrinsic degeneration of the tendon. During the rupture the person feels a whiplash or dagger thrust-like pain, followed by restricted walking ability and decreased plantar flexion of the ankle. The positive Simmond/Thompson test and a palpable dent above the tendon rupture are pathognomical. Diagnostically, ultrasound of the tendon and lateral x-ray of the calcaneus (bony pull-out of the tendon insertion) are necessary. Regarding correct indication and treatment modalities, most established conservative and surgical therapies realize optimal functional results. Surgical treatment promises better primary stability and slightly earlier better functional results, but there is the potential for surgical complications. Conservative therapy is associated with higher rates of re-rupture and healing of the tendon under elongation. Therefore, therapy planning in Achilles tendon rupture should be determined based on each patient. We recommend surgical treatment in patients with higher sporting demands and in younger patients (相似文献   

Die Lungenembolie

Ohne ZusammenfassungMit 2 Abbildungen     

Die Meatusstenose

There is no common pathology in strictures of the external urinary meatus in men and women. These strictures have to be considered in their complexity and history with influential factors like additional diseases and previous surgical interventions. It is necessary to distinguish a simple situation from extensive findings. Successful therapy depends on the exact evaluation and classification of the stricture.     

Die Brustwandresektion

Ohne Zusammenfassung     

Die Naviculare-Pseudarthrose

Ohne Zusammenfassung Mit 34 Textabbildungen.     

Die Pantopon-Skopolaminnarkose

Ohne Zusammenfassung     

Die Transilluminationstechnik

The technique of light-guided intubation is based on the principle that a source of light brought into the trachea results in clearly visible and defined transcutaneous illumination, while no illumination can be observed with the light source in the oesophagus (Fig. 1–7). The Trachlight^® is a reintroduced instrument for this alternative intubation technique. The essential developments are: a length-adjustable stylet with a removable internal metal wire, a brighter light source, a stable handle with tight fixation of the endotracheal tube, and a time-dependent warning device to avoid extended intubations. One hundred twenty patients (Mallampati I, ASA I–III) were included in the study (conventional intubation [group KL, n=60], Trachlight^® intubation [group TT, n=60]. The goals of the investigation were to examine the handling, application, problems, limitations, and possible indications of the method. The recorded parameters were: number of intubation attempts: course and duration of intubation; complications; and difficulties. In 40 patients (20 in each group) the indication for invasive blood presure measurement was given due to the surgical procedure, and circulatory parameters were recorded at defined moments during the intubation course. In group KL 55 patients were intubated in the attempt, 4 on the second, and 1 on the third (mean duration 23.6±10.4 s, range 12–60 s). Complications were: unilateral intubation (3 patients), bradycardia (2), asystole (1) and soft-tissue injury (1). Of the 60 patients in group TT, 54 were intubated successfully, the mean time needed being 29.9±14.8 s (range: 6–61 s). The remaining 6 were then intubated by the conventional method. Positive results in group TT included: easy handling and application, no injury to soft tissues or teeth, and invariably correct placement of the tube. Problems included: sufficient transillumination was achieved only after (entire) dimming of the room, insufficient control over the distal end of the tube due to an unfixed metal wire, unintentional switching off of the light while with-drawing the metal wire, difficulties in with-drawing the metal wire (too strong fixation), as well as disturbing effects of the warning device (blinking of the light 30 s after switching on). Reasons for the 6 intubation failures were introduction of the instrument into the oesophagus despite a supposed correct position, impossibility of correct placement in a patient with an extremely large goiter, and insufficiently clear transillumination in 3 extremely obese patients. The cardiovascular parameters showed no changes during laryngeal manipulation; a clear rise in heart rate and blood pressure was recorded, however, when the tube was inserted into the trachea. The cardiovascular parameters during conventional intubations were similar. The light-guided intubation technique can be regarded as a further alternative for airway management, due to the described improvements of the instrument. The indication for the technique is given in patients in whom no difficulty with intubation is expected, to avoid soft tissue damage and traumatising temporomandibular joint movements. Preclinical use may be limited due to environmental brightness. In patients with expected difficult airway management, fiberoptic intubation will remain the method of choice.     

Die Fersenbeinzyste

Ohne Zusammenfassung     

Die GABAA-Rezeptor-Familie

ABTRACT: Clinically used anesthetics show amnestic, sedative, hypnotic and immobilizing properties. On a molecular level these drugs affect several receptors in the cell membrane of neurons. By using genetically engineered mice a linkage can now be made between actions on certain receptors and clinically desired and undesired effects. Experiments show that a certain GABA(A) receptor subtype mediates hypnosis and immobility, whereas another subtype is involved in side-effects like sedation and hypothermia. These findings form the basis for the development of new drugs, acting highly specific and with fewer side-effects.     

Die TNK-Sprunggelenkprothese

Total ankle replacement has been introduced in the last 30 years. The TNK ankle is build from ceramics, and it was continuously improved. This prosthesis has the longest fellow-up times.Seventy ankle prostheses of the newest generation has been implanted between 1991 and 2001. Of these, 67 prostheses were assessed clinically and radiographically after 62 months (range, 24 to 132 months). Three ankles have been revised. The clinical score improved for the patients with primary or posttraumatic arthritis from 34 to 86, and for the patients with rheumatoid arthritis from 45 to 74. Loosening was found in 4 ankles with non-rheumatoid arthritis, and in 17 ankles with rheumatoid ankles. Total ankle replacement has emerged to a valuable alternative to ankle arthrodesis, and satisfactory results have been achieved with the current implants. The bone-implant interphase might play a most important factor for success. There is evidence that the biologic advantages of ceramics may help to improve long-lasting success in total ankle replacement.