Die kongenitale Tibiahemimelie

Background

The congenital tibia hemimelia, also called tibial deficiency, is a rare disorder with unknown cause, showing many associated abnormalities or varying syndromes.

Methods

The correct diagnosis can be easily established using radiographs and/or magnetic resonance imaging in the postpartum setting. However, treatment may be difficult and needs to take into consideration the given anatomic situation in the knee and ankle joint.

Conclusion

Prosthetic fitting may be possible in mild cases. Nevertheless, the majority of patients need to undergo surgical reconstruction in order to restore a functional, mobile, and stable knee and ankle joint.     

Die kongenitale Knieverrenkung

Zusammenfassung Autoren erörtern die Häufigkeit, Ätiologie, klinische Symptome, Klassifikation und Behandlung der angeborenen Knieverrenkung, dann beschreiben sie ihre 8 Fälle. Sie stellen fest, daß die kongenitale Knieverrrenkung durch konservative Frühbehandlung gut zu beeinflussen ist. Die mit Gipsverband durchgeführte Etappe-Redression hindert die funktionelle Behandlung der Hüftverrenkung durch Riemenbügel nach Pavlik nicht, sogar die angeschlossenen Fußdeformitäten sind parallel zu korrigieren. Sie betonen die Notwendigkeit der sog. Frühestbehandlung, die bei allen drei Veränderungen (Knieverrenkung, Hüftverrenkung, Klumpfuß) eine äußerst große Bedeutung hat.

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Congenital dislocations of the knee joint

Summary The authors discuss the frequency, etiology, clinical symptomatology, classification, and treatment of congenital dislocations of the knee joint. They present 8 cases of their own material. The congenital knee joint dislocation can be treated conservatively with good results. Treatment with plaster casts does not interfere with treatment of simultaneous hip dysplasias in Pavlik bandages. Even foot deformities can be treated at the same time. They emphasise the need for earliest treatment which seems equally important for all three deformities: knee joint dislocations, hip dysplasias, and club feet.

     

Frakturtyp und Vorbehandlungsart als Ursachen der Tibiapseudarthrose

Zusammenfassung An 71 Fällen von Tibiapseudarthrosen wurden katamnestisch die Ursachen der ausbleibenden Knochenbruchheilung untersucht. Als wichtiger Faktor wird neben der Schwere des Traumas der Frakturtyp angesprochen. Vor allem Quer- und Schrägbrüche sowie alle Bruchformen im distalen Tibiaschaft — diese vorwiegend bei Patienten über 30 Jahre — neigen zur Falschgelenkbildung. Eine wesentliche Rolle spielt zudem die Art der Vorbehandlung. Unsachgemäßer Dauerzug und technisch insuffiziente Osteosynthesen sind vor den septischen Komplikationen die häufigste Ursache der Pseudarthrose.

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Type of fracture and initial treatment followed by a pseudarthrosis of the tibia

Summary In a retrospective study, the causes for delayed healing were examined in 71 tibial pseudarthroses. A decisive factor seems to be the type of fracture along with the severity of the trauma. Transverse and oblique fractures plus all fracture types in the distal shaft — particularly in patients over 30 years of age — have a tendency for pseudarthrosis formation. The initial treatment plays an important part. Unwarranted continuous traction and technically incompetent osteosynthetic procedures are apart from the septical complications the most frequent causes for the formation of pseudarthroses.

     

Die Kamptodaktylie

Ohne Zusammenfassung Mit 10 Textabbildungen.     

Die Knotenformen

Zusammenfassung Die Knotenformen zeigen, da? sowohl der Schifferknoten wie der Weiberknoten bei richtiger Zusammenziehung sehr fest ist. Fehlerhaft sind die doppelt überschlungenen Knoten, welche je nach der Art der Knüpfung verschiedene Formen annehmen; aber alle sind von minder-wertiger Festigkeit. Die chirurgische Knüpfung entbehrt der Sicherheit, wenn auf ihn nur eine einfache Knüpfung aufgesetzt wird. Die volle Festigkeit erteilt ihm erst der hinzugefügte Schifferknoten. Mit 7 Textabbildungen.     

Die Musculus-peroneus-brevis-Lappenplastiken

Objective

Soft tissue defect reconstruction by transposition of well-vascularized muscle tissue with a muscle flap and as an osteomuscular flap together with a fibular bone segment for combined skeletal and soft tissue defects.

Indications

Small- and medium-sized defects of the hindfoot, around the ankle and the distal and middle third of the lower leg, skeletal reconstruction of underlying small- and medium-sized bone defects.

Contraindications

Lesions of the proximal anterior tibial artery (proximal pedicled flap), combined lesions of the distal peroneal artery including the communicating branch with the posterior tibial artery (distal pedicled flap); lesion or paralysis of the peroneus longus muscle in an intact ankle joint.

Surgical technique

Distally pedicled flap: blunt separation between the peroneus longus and brevis muscle, subperiosteal release with isolation on a distal septocutaneous branch of the peroneal artery. To increase perfusion, the proximally released branch of the anterior tibial artery may be re-anastomosed in the recipient site. Proximally pedicled flap: dissection of distal peroneus brevis muscle tendon and subperiosteal release in a proximal direction with ligation of the segmental peroneal artery branches until the flap is isolated on its proximal anterior tibial artery branch. For an osteomuscular flap, simultaneous harvest of a fibula segment underneath the muscle origin with preservation of the intimate periosteal relationship between muscle and bone.

Postoperative management

Complete immobilization and elevated leg position for 5 days, followed by successive orthostatic training for 10 days. Postoperative standardized compression garments for 6 months, eventually combined with silicone sheet scar therapy.

Results

Reliable, excellent functional and aesthetic results with very low donor site morbidity.     

Die GSB-Ellbogen-Endoprothese

Zusammenfassung Die GSB-Ellbogengelenksprothese ist eine Neukonstruktion. Sie erlaubt eine minimale Knochenresektion, wird mit Knochenzement verankert und ermöglicht selbst im schlimmsten Fall (Infektion) einen sicheren Ausweg. Die mit dieser Totalprothese vorwiegend bei schmerzhaft zerstörten oder ankylosierten, polyarthritischen Ellbogengelenken erzielten Ergebnisse werden vorgestellt und die Vorteile gegenüber den bisher gebrauchten Methoden analysiert.

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Elbow arthroplasty with the new GSB-prosthesis

Summary The authors present a new artificial elbow hinge-joint (GSB prosthesis) whose main advantage is to allow a successful retreat (second line of defense Charnley) after a possible failure (i.e. infection). The indications, operative technic and after-care are discussed in detail and a case report is presented.

     

Die Ender-Nagelung

Operationsprinzip Belastungsstabile intramedull?re Osteosynthese proximaler Femurfrakturen durch frakturfern eingebrachte sogenannte Federn?gel. Zus?tzliche Eingriffe im Frakturbereich wie Einbringen von Zement, Schrauben, Drahtcerclagen oder Osteotomien belasten das Verfahren unangebracht und beeintr?chtigen seinen Wert. Die Technik wurde von Ender u. Simon-Weidner [5] eingeführt und erstmals 1970 beschrieben.      

Die Ellbogengelenksluxation

Thorough knowledge of the anatomy and biomechanics in the elbow joint together with an especial reference to constitutional variations is an important factor in understanding the pathomechanisms of its dislocation. We are presenting 28 case-reports of elbow-dislocations treated at the I. University Clinic for Traumatology in Vienna between 1979 and 1983. The so-called carrying angle showed no pathological deviation besides a tendency to cubitus valgus and hence elbow-joint to dislocation. Our results showed clearly that conservative treatment is possible and advisable in most cases. Only dislocation with osseous lesions and/or a tendency to redislocation after reduction should be operated on.     

Die Vidierkonferenz

INTRODUCTION: The introduction of the German Diagnostic Related Groups (D-DRG) system requires redesigning administrative patient management strategies. Wrong coding leads to inaccurate grouping and endangers the reimbursement of treatment costs. This situation emphasizes the roles of documentation and coding as factors of economical success. PURPOSE: The aims of this study were to assess the quantity and quality of initial documentation and coding (ICD-10 and OPS-301) and find operative strategies to improve efficiency and strategic means to ensure optimal documentation and coding quality. METHODS: In a prospective study, documentation and coding quality were evaluated in a standardized way by weekly assessment. RESULTS: Clinical data from 1385 inpatients were processed for initial correctness and quality of documentation and coding. Principal diagnoses were found to be accurate in 82.7% of cases, inexact in 7.1%, and wrong in 10.1%. Effects on financial returns occurred in 16%. Based on these findings, an optimized, interdisciplinary, and multiprofessional workflow on medical documentation, coding, and data control was developed. CONCLUSIONS: Workflow incorporating regular assessment of documentation and coding quality is required by the DRG system to ensure efficient accounting of hospital services. Interdisciplinary and multiprofessional cooperation is recognized to be an important factor in establishing an efficient workflow in medical documentation and coding.     

Die Alveolargasgleichung

Ohne Zusammenfassung