Double fractures of the bones of the crus and their treatment

The authors have studied 256 patients with double fractures of the bones of the crus, the basis of the analysis of the causes, the mechanism of the origin and the clinico-roentgenologic picture a classification of the lesions and a number of new methods of treatment have been worked out which provide reposition and fixation of the fragments, prevent the development of early and late complications and contribute to reduction of the terms of treatment and disability. The method of treatment of double fractures of the bones of the crus with permanent skeletal traction has been improved. A method of insertion of metal rods into the tibia in cases of double fractures of the tibia with oblique planes of the fractures has been technically substantiated. A method of intraosseous administration of antibiotics and drugs and a method of subcutaneous fasciotomy (a. c. No. 1113098) with a fasciotome of the author's construction has been proposed. The application of a shock-proof clip of our construction (a. c. No. 310659) and slides in the joints (a device with rollers for a hinged plaster cast) contributed to an early recovery of the support function of the injured extremity. The long-term results of the treatment have been studied in 211 patients with double fractures of the bones of the crus and an analysis of rational use of the proposed methods of treatment has been made. To evaluate the results of the treatment the authors have applied clinical, roentgenologic, electrophysiologic, biomechanical and statistical methods of investigation. The results are positive in most cases.     

A rare case of closed isolated dislocation of the third metacarpophalangeal joint of the hand

Metacarpophalangeal joint [MCP] dislocations of the index, little and thumb are common; that of the middle finger is very rare. In all the literature consulted only five cases of isolated closed dorsal dislocation of the MCP joint of the middle finger have been reported. Hyperextension of MCP joint is the mechanism of injury. We are herewith reporting a case of isolated MCP dislocation of the middle finger.One of our medical students while driving a motorcycle fell down on the road and sustained lacerated wound over the hypothenar area of the left hand. There was prominence of the head of the third metacarpal on the volar aspect and the base of the proximal phalanx was prominent dorsally. MCP dislocation of the middle finger was our clinical diagnosis which was confirmed by the radiograph. The patient had reported within 60 min of the accident.There was no tendon injury. Wound debridement was done, wound was extended to the back of the middle finger. The volar plate which was interposed between the head of the metacarpal and the base of the proximal phalanx was repositioned and the dislocation was reduced. Reduction was stable and the patient was reviewed after 14 months. The function of the hand is satisfactory.The case is presented for its unique presentation. This is the sixth case of isolated dislocation of the MCP joint of the middle finger.     

Stabilization of the injured acromioclavicular joint using a new type of fixation plate]

The opinions in the question of transitory fixation of the joint during the treatment of the acromioclavicular articulation are rather different. The complications of the widely used methods--break of the implant, its tear from the bone, the wandering and the disturbances of wound healing--are well known. To decrease the number of complications authors have developed a new type of hooked plate. The plate is fitted to the anterior surface of the acromial end of the clavicle and its hook is fixed from below in the bore hole of the acromion. To choose the optimal place of the bore hole a drill guide was prepared. The operative method is described and the advantages of the method are summarized. The "Debrecen-plate" was used during 2 years in 39 injuries. 35 patients were controlled 6-24 months after the operation. Based on the results of the treatment a wider use of the method is suggested.     

胶原酶在髌骨软骨软化中的作用

２４只新西兰兔，随机分４组。右膝髌骨手术方法造成髌骨倾斜状态为实验侧，左膝实施假手术为对照侧，定期处死动物后进行髌骨软骨面接触压力测量、软骨组织病理观察以及胶原酶免疫组化（ＬＡＢ法）定位。结果：实验膝髌骨倾斜后导致髌内侧面软骨接触压力降低，而髌外侧面软骨接触压力无明显变化；组织病理显示：髌内侧面软骨中层至深层明显变性、软化，髌骨外侧面软骨变性不明显；免疫组化染色显示：髌内侧面软骨中层、深层软骨细胞浆与周围软骨基质胶原酶明显增多，且自软骨下骨长入钙化层或深层的血管内皮细胞以及软骨裂隙边缘处胶原酶强阳性。而髌外侧面软骨胶原酶含量无明显增多。表明：软骨胶原酶增多部位与髌骨软骨软化发生部位及其程度相一致。作者认为，胶原酶对髌骨倾斜导致髌软骨软化过程中软骨基质的破坏起重要作用。     

Vertebral hemangioma with neurologic signs. Clinical presentation, results of a survey by the French Society of Neurosurgery

45 cases of vertebral hemangiomas with neurologic involvement are reported. This series corresponds to the french experience between 1969 and 1988 (series of the "Société Fran?aise de Neurochirurgie" (S.F.N.)). In this report the clinical presentation and the results of the radiological examination are detailed. Local vertebral pain was present in half of the cases. The neurological symptoms were related to spinal cord compression in 33/45 of the patients and to radicular suffering in the other cases. Evolution of the neurological symptoms appeared to be slow: the mean evolution time before diagnosis was of 10 months. Hemangioma involved the thoracic column in 73% of the cases. Neurologic symptoms was due to a diffuse narrowing of the spinal canal in 28.8% of the cases, to a local bony expansion in 60% of the cases. Hemangioma was found to involve the whole vertebra in 44.4% of the cases, the vertebral body alone in 24.4% of the cases and the posterior arch alone in 22.2% of the cases. An incomplete involvement of both vertebral body and posterior arch was found in 6.6% of the cases. 2.2% of the cases corresponded to pure epidural hemangioma. Preoperative diagnosis was established in 58% of the patients. In these cases, the diagnosis was based on standard radiography and CT datas. Results of the S.F.N. serie are compared with those of the main series of the literature.     

The operative cure of hallux valgus and bunions

The main basic factors in the etiology of hallux valgus and bunions are the adduction of the metatarsal bone of the big toe and the obliquity of its tarsometatarsal joint.The conspicuous and obvious causes of the discomfort and disability are the valgus of the big toe, bony overgrowth at the base of the big toe and the overlying bursa or bunion.The author's operation aims to correct all of the pathological changes without disturbing the function of the big toe joint or the weight bearing surface of the head of the first metatarsal.The adduction of the first metatarsal bone is corrected by the removal of a double wedge from the tarsometatarsal joint, the mobilization of the metatarsal bone and the manual approximation of the first and the second metatarsal.The overgrowth of bone on the head of the metatarsal and the bunion are excised through a separate incision.The correction of the valgus of the big toe is assured by securing to the metatarsal bone a tongue of strong tissue, consisting of bursal wall and capsule, which is attached to the base of the phalanx.Care is exercised not to remove or in any way disturb the articulating portion of the head of the metatarsal bone. This accomplishes two results, namely, the support of the forefoot is not altered and the mobility of the big toe is not diminished.By bringing the big toe into line with the inner border of the foot, the sesamoid bones are returned to their normal relation to the head of the metatarsal, and the dorsal and plantar tendons of the big toe are brought into a normal or nearly normal position, where they can function properly.     

益气温阳、活血化瘀方对兔血管成形术后再狭窄PDGF-B mRNA表达的影响

目的探讨中药复方对兔实验性经皮腔内血管成形术(PTA)血管成形术后血管壁血小板衍生生长因子B链(PDGF-B)mRNA表达的影响。方法新西兰兔54只随机分为假手术组、模型组、中药组,采用一次球囊导管损伤方法制备兔颈动脉球囊损伤模型,于术后1周、2周、4周取材,HE染色进行定量组织形态学分析和RT-PCR法半定量检测分析PDGF-B mRNA的表达。结果中药组、模型对照组与假手术组相比,管腔狭窄程度明显加重,内膜与中膜面积之和明显增大;与模型组相比,中药组在2周、4周时管腔面积明显增大、管腔的狭窄程度、内膜与中膜面积之和显著降低,在1周、2周时PDGF-B的mRNA表达水平明显增高。结论益气温阳、活血化瘀方可能通过下调血管壁PDGF-B的mRNA表达水平,从而抑制平滑肌细胞的增殖和血管成形术后再狭窄。     

Management of open, potentially infected hand injuries with bone defect by delayed early bone substitution

Authors make an analogy between the principles of treatment of the fresh, potentially infected injuries with bone and soft tissue defects and of the already developed manifest infection of the hand. The principles of treatment are essentially the same. First of all the fixateur externe and the antibiotics containing globules are suggested for the sanation and prevention of the disease equally. Attention is called to the fact, that better results can be expected from the prophylaxis than from the attempts to make the process reversible. The beneficial synergism of the extrafocal fixation and the intrafocally acting antibiotics will help. One of the secrets of the good late functional results is the early restitution of the architecture of the bones of the hand. For this, the authors suggest the most modern replacement of bone in the form of primary delayed cancellous bone plasty, performed within two weeks.     

上臂远端外侧肱骨骨皮瓣修复手部复合组织缺损

目的 探讨上臂远端外侧肱骨骨皮瓣在手外科的临床应用效果.方法 对8例手部复合组织缺损的患者,根据掌指骨缺损的情况,先设计骨瓣的切取位置和大小(骨瓣远端止于肱骨外上髁的上缘),然后再根据皮肤缺损的面积和骨缺损的相对位置设计皮瓣的大小.前臂后皮神经位于皮瓣的中轴线上,可以保留或一并切取使用,恢复受区感觉.皮瓣切取面积为4.0cm×8.0cm～6.0cm×8.0cm,骨瓣切取大小为4.0cm×1.5cm×1.0cm～6.0cm×1.5cm×1.0cm.结果 术后8例骨皮瓣全部存活,上臂供区创面直接闭合,愈合好,上臂功能无影响.术后随访4～24个月,皮瓣感觉恢复良好,移植骨完全愈合,手部外形满意.结论 上臂远端外侧肱骨骨皮瓣是修复手部创面和掌、指骨复合组织缺损的理想选择.     

The early identification and classification of growth disturbances of the proximal end of the femur

An analysis of the serial radiographs of sixty-eight patients who were treated for congenital dislocation of the hip revealed that a growth disturbance of the proximal end of the femur that was caused by partial or complete physeal closure developed in thirty-three of these patients. The disturbances were related to the character of the metaphyseal growth-disturbance lines and were subsequently classified according to the site and extent of physeal closure. In order to study this problem, we divided the physis of the proximal end of the femur into two contiguous sections: a medial and a lateral portion. Two typical patterns of premature closure were identified: one located at the junction of the medial and lateral portions of the physis and the other located in the area of the medial portion of the physis alone. The pattern of physeal closure, together with the age of the patient at the time of closure, determines the subsequent growth of the proximal end of the femur. The final outcome of growth of the proximal end of the femur can be predicted within six months after the initial treatment. Epiphyseal changes were found to be of no prognostic significance in the absence of physeal closure.     

Parosteal osteosarcoma of the posterior aspect of the distal part of the femur. Oncological and functional results following a new resection technique

BACKGROUND: Parosteal osteosarcoma is a low-grade malignant bone tumor that arises from the surface of the metaphysis of long bones. Parosteal osteosarcoma is usually well differentiated and displays a low propensity to metastasize. Wide resection of a parosteal osteosarcoma has been shown to provide a relatively risk-free method of preventing local recurrence. We propose a new method of resection of parosteal osteosarcomas located in the popliteal paraosseous space of the distal part of the femur. This method involves resection of the mass through separate medial and lateral incisions, which allows for wide margins yet limits the amount of dissection of the soft tissues and the neurovascular bundle. METHODS: Six patients with parosteal osteosarcoma located on the posterior aspect of the distal part of the femur underwent resection of the lesion and reconstruction with a posterior hemicortical allograft through dual medial and lateral incisions. The patients were evaluated with regard to pain, postoperative function, union of the allograft (osteosynthesis), and the prevalence of local recurrence. RESULTS: The average time until the last follow-up assessment was 4.3 years. No metastases developed, and there were no local recurrences. All patients were free of disease at the last follow-up evaluation. Postoperatively, the average range of motion of the knee was 0 to 122 degrees. Five of the six patients were free of pain at the time of the latest follow-up. Five of the six patients returned to their preoperative active functional status. CONCLUSIONS: We recommend resection of a parosteal osteosarcoma located on the posterior surface of the femur through separate medial and lateral incisions. This approach provides minimal dissection of the neurovascular bundle but ample exposure for reconstruction with a hemicortical allograft.     

优化的外踝上皮瓣修复足踝部皮肤软组织缺损

目的总结应用优化的外踝上皮瓣逆行转移修复足踝部皮肤软组织缺损的临床效果。方法2016年1月至2019年6月,漯河医学高等专科学校第二附属医院显微骨科收治16例足踝部中小面积皮肤软组织缺损患者,其中男12例,女4例;年龄18~63岁,平均48岁。应用优化的外踝上皮瓣进行修复。术前测量创面宽度,在小腿中下部或中部前外侧利用"提捏法"评估供区,确认可直接闭合。多普勒超声血流仪探测外踝上腓动脉终末穿支及近侧穿支,两穿支标记点连线为皮瓣中轴线,旋转点在外踝平面或下胫腓联合上缘水平,旋转点至创面近侧缘距离作为血管组织蒂长度,术中注意保护皮瓣蒂内的穿支血管及腓动脉终末穿支降支血管,小血管夹夹闭外踝上腓动脉终末穿支近侧的穿支血管后,放松止血带,评估皮瓣血运,必要时可打开骨间膜携带腓动脉。经明道转移皮瓣,并将蒂部覆盖的皮瓣优化设计成钝弧形或半圆形。对踝周及足底皮肤缺损的4例患者,将皮瓣近心端腓浅神经与腓肠神经端侧吻合。供区直接拉拢缝合。术后观察皮瓣成活情况。结果本组16例,皮瓣切取面积3.0 cm×1.5 cm~14.0 cm×6.0 cm。仅1例术后24 h出现皮瓣淤血肿胀,远端血运差,给予拆除蒂部部分缝线,1周后皮瓣尖端仍出现小面积坏死,经换药后愈合,其余皮瓣未经特殊处理顺利成活。共12例患者得到有效随访,随访时间为4个月至2年,皮瓣外形及功能满意。吻合神经的4例患者中3例得到随访,随访时间8~13个月,皮瓣感觉恢复至S2级1例,S3级2例。结论通过对皮瓣供区优化选择、皮瓣血管蒂长度及明道转移的优化设计,以及术中对皮瓣血运的评估与优化处理,不但提高了皮瓣成活率,而且获得了良好的外形与功能,虽部分患者因切取腓浅神经后可遗留不同程度的足背皮肤感觉功能障碍,但仍不失为修复足踝部中小面积皮肤软组织缺损较为理想的方法之一。     

Method of surgical treatment of critical ischemia of lower extremities in patients with occlusive injuries of shin arteries

The work describes a new method of restoration of blood circulation in patients with critical ischemia of the lower extremities of atherosclerotic genesis with a distal type of damage of the arterial bed. In 52 patients with the saved lumen of the distal part of the shin and little capacity of the distal bed reconstructive operations were performed by the developed technique. Reconstructive operations were fulfilled on 45 (86.5%) patients with the saved patency of the distal third of the posterior tibial artery, in 7 (13.5%) patients--of the anterior tibial artery. Thrombosis of the arterial bed occurred in 2 patients with saved patency of the vein in 3 weeks after operation. No recurrence of the critical ischemia of the extremity was observed. Thrombosis of the distal segment of the foot vein was found in 3 patients with the saved patency of the arterial bed in the period from 3 days to 4 weeks. Thrombosis of the venous shunt due to embolism of the cut off cusps of the venous valve was observed in 2 patients on the first day after operation. Thromboectomy from the shunt was fulfilled in these patients followed by recovery of blood circulation. Long-term results were followed up to 24 months. The shunt patency was 68%, the extremity was saved in 87% of the cases.     

Basement membrane alterations during development and regression of tubular cysts

Tubular cysts consisting of dilatation of the collecting ducts at the level of the subcapsular zone of the kidney were induced in newborn rabbits by a single injection of methylprednisolone acetate. We describe here the structural and compositional modifications of the tubular basement membrane (BM) during the formation, growth, and regression of the tubular cysts. During development of the tubular cysts the cystic BM appeared thickened and multilayered, with numerous matrix vesicles. Alcian blue- (AB) and ruthenium red- (RR) positive material distributed differently along the BM of control and cystic tubuli. While the amount of RR-positive material appeared increased in the cystic BM, no differences in the intensity of the AB staining could be discerned between normal and cystic tubuli. Immunofluorescent staining for laminin and type IV collagen appeared to be slightly decreased in the cystic tubuli. However, the amount of fibronectin appeared clearly increased. These changes in the cystic BM appear at the beginning of the tubular dilatation and are not observed in other renal BM. We suggest that there is a causal relationship between the modifications of the BM and the development of the tubular cysts. Glucocorticoids appear to modify the synthesis and/or secretion of the BM components. An abnormal BM should modify the spatial and chemical signals encoded within the BM that, in turn, could lead to abnormal behavior of the tubular cells. This may result in a loss of the normal developmental constraints imposed upon the tubular epithelium, which then undergoes cystic dilatation. During the regression of the cysts, the abnormalities of the BM progressively disappear. The sharp increase in the number of interstitial cells, which show close relationships with the components of the BM, suggests that these cells may be involved in the removal of the cyst BM.     

Surface replacement of the hip

Summary Surface replacement of the hip has been performed in 25 rabbits. Twenty animals were chosen for evaluation of the result of the operation after an average period of five months postoperatively.Tetracycline injections were given for fluorochrome labeling and radiographic controls have been made in vivo to check the position of the cup before the animals were sacrified.Histological examinations were made from slides, which were gained after the metal cup had been removed with the bone cement still in place.It was found that the bone underneath the cup survived the surface replacement and that there was a normal metabolism furtheron.The trabeculae even grew into the surface structures of the inner layer of the bone cement and there was no interposition of membranes of fibrous tissue.It could be demonstrated that fibrous tissue between bone and bone cement is found only in cases of loosening of the cup and the cement or in cases of insufficient contact between this interface from the moment of the operation on. This is possible when airbubbles arise in the bone cement and get in contact with the trabeculae of the femoral head.Fluorochrome labeling proved the formation of new bone underneath the cup and the survival of the osseous structures of the coxal end of the femur.We believe, that in clinical cases it is necessary to remove all predamaged cancellous bone from the head of the femur (i.e. in cases of avascular necrosis) before the cup is attached. Close contact between the bone cement and the healthy spongiosa is one of the conditions for success in surface replacement of the hip.     

Test bed for assessment of the kinematical determination of navigation systems for total knee arthroplasty. Does a limited range of motion of the hip joint influence the accuracy of the determination?

OBJECTIVE: To locate the rotational center of the hip joint, CT-less navigation systems for artificial knee-joint replacement use movements of the femur with a rigid body attached. It cannot be assumed that the hip joint provides free mobility at all times. The purpose of the present study was: 1) To build a mechanical model to assess the system's accuracy in locating the rotational center of the hip by simulating a step-wise reduction of the range of motion (ROM) of the hip joint. 2) To determine the system's resolution by assessing a critical distance between two positions of the same femoral rigid body during the process of locating the rotational center of the hip. 3) To determine the sensitivity of the navigation system to the rotation of a femoral rigid body relative to the femoral bone while locating the rotational center of the hip joint. MATERIAL AND METHODS: To assess the impact that a limited ROM of the hip joint has on the accuracy of determination of the hip joint's rotational center, a test bed was built. This enables validation of the algorithm used by a CT-less navigation system. RESULTS: In the first part of the study, it was shown that a reduction of the ROM of the hip joint to 30% of its initial value had no evident influence on the accuracy of locating the rotational center of the joint. In the second part of the study, it was determined that the limit of resolution between two spatial points of the pivoting process is between 4.4 and 8.7 cm. The third part of the study showed that the examined system rejected the determination of the hip center even when the rigid body was only rotated through 22.5 degrees . CONCLUSIONS: The results show that osteoarthritis of the hip with a limited ROM, for example, cannot be taken as a contraindication for the use of the evaluated CT-less navigation system. However, the surgeon should ensure that the pivoting of the femur is performed without hindrance within the free range of motion of the hip joint. In accordance with the vendor's recommendation, a minimum distance of 10 cm should be maintained between two spatial points. To ensure safe and unconstrained operation, the rigid body must be firmly attached to the bone and must not be dislocated.     

How does a femoral varus osteotomy alter the natural evolution of Perthes' disease?

To study how a femoral osteotomy alters the natural evolution of Perthes' disease, records and radiographs of 640 patients with Perthes' disease were analyzed. The data of 314 patients who underwent femoral osteotomy were compared with those of non-operated patients. A new modification of classification of the stages of evolution of the disease was used to identify the timing of surgery and to monitor the progress of the disease following surgery. The duration of each stage of the disease, the extent of epiphyseal extrusion, the extent of widening of the femoral metaphysis and the dimensions of the acetabulum were noted on sequential radiographs. The changes in the femoral epiphysis and metaphysis and changes in the acetabulum were also noted. It was observed that a varus osteotomy clearly alters the natural evolution of Perthes' disease. Of patients who were operated in the stage of avascular necrosis, 34% bypassed the stage of fragmentation. The duration of the disease was shorter in these patients. The duration of the stage of fragmentation was reduced in operated children who passed through the stage of fragmentation. The extent of femoral head extrusion was minimized at the stage when it was most vulnerable for deformation. Metaphyseal widening and subsequent femoral head enlargement were also minimized in children who underwent a femoral osteotomy. The chances of retaining the sphericity of the femoral head were much higher in those children who had a femoral osteotomy. These beneficial effects of a varus osteotomy, were most evident when the operation was performed either in the stage of avascular necrosis or in the early stage of fragmentation.     

Meningioma of the apex of the tentorial incisura. Diagnostic and surgical aspects apropos of a series of 7 cases

Seven cases of meningiomas implanted on the medial portion of the free edge of the tentorium are reported. The denomination "meningiomas of the apex of the tentorial incisura" is proposed. In 4 patients, the clinical presentation was that of an intracranial hypertension without signs of compression of the quadrigeminal plate involvement. In the other 3 patients, the initial symptoms were those of the triad of the adult chronic hydrocephalus (N.P.H.) syndrome. Angiographic evaluation provides useful informations on the arterial supply (which is mainly from the tentorial branches of the internal carotid arteries and occasionally from the middle meningeal arteries) and the relationships of the tumor with the deep venous system. C.T. and M.R.I. facilitate earlier diagnosis and better demonstration of implantation and extension of the tumor, which the selection of a surgical approach is based upon. Four patients have undergone an occipital supratentorial approach and 2 a supra-cerebellar infra-tentorial approach. The meningioma was totally removed in 5 patients, sub-totally in 1 to avoid bilateral lesions of the visual pathways and cortical areas. The 7th patient was treated by C.S.F. shunt alone. No operative mortality occurred. The follow-up is averaging 18 months: 4 patients are symptom-free, 3 exhibit minor sequelae (epilepsy: 1, visual field defects: 2, memory impairement: 2). Six patients of the series have resumed their previous activities. Discussion is focused on the difficulties of surgical removal of this particular type of tentorial meningioma, resulting from volume, implantation and relationships of the tumor with the deep veins.(ABSTRACT TRUNCATED AT 250 WORDS)     

The adductor hallucis revisited

To evaluate anatomic variability in the insertion of the adductor hallucis into the lateral sesamoid and proximal phalanx of the great toe and to evaluate the extent of release of the adductor hallucis tendon performed through an incision in the dorsal first-web space, we recorded the angle of hallux valgus in 42 fresh-frozen specimens from human cadavers. An incision was made for a realignment of the soft tissues, dissecting down to the level of the intermetatarsal ligament. A loop of suture was placed around the identifiable adductor hallucis tendon through this incision along the lateral aspect of the lateral sesamoid. Then a plantar dissection removed all soft tissue to the level of the intermetatarsal ligament, adductor hallucis (transverse and oblique heads), lateral sesamoid, and lateral flexor hallucis brevis. The Insertion of these muscles into the proximal phalanx was evaluated. Specifically, we looked for separate slips of the adductor tendon inserting into the base of the proximal phalanx or separate insertions of the adductor tendon and the tendon of the flexor hallucis brevis muscle. In 33 of the 42 specimens, the entire adductor hallucis tendon had been isolated by the loop of suture through the incision in the dorsal first web. In eight of the remaining nine specimens, a small slip of the tendon (comprising less than 25% of its substance) had not been included. No specimen was found to have a separate slip of the adductor tendon inserting into the base of the proximal phalanx. Instead, all specimens were found to have only a conjoined insertion of fibers of the adductor hallucis and of the flexor hallucis brevis from the lateral sesamoid into the base of the proximal phalanx. We did not identify a separate tendon-insertion into the proximal phalanx in any specimen. Therefore, great caution should be exercised in releasing an isolated insertion of the adductor tendon from the base of the proximal phalanx of the great toe since it may actually represent the conjoined insertion of the lateral flexor hallucis brevis tendon and the adductor tendon. We found that by simply releasing the adductor tendon from its insertion along the lateral aspect of the sesamoid, accomplished through an incision in the dorsal first web, that an adequate release was achieved in most specimens.     

Errors in the diagnosis of traumatic ruptures of the diaphragm

Traumatic ruptures of the diaphragm were analyzed in 18 cases. The main causes of errors in the diagnosis of the injury were considered to be the following ones: 1. the underestimation or misunderstanding of different clinico-roentgenological forms of injuries of the diaphragm and resulting peculiarities of the course of the disease; 2. simultaneous injuries of the abdominal cavity organs; 3. the underestimation of severity of the trauma.