Osteosynthesen bei subtrochanteren Femurfrakturen

The continuous developments in operative techniques and implants have contributed to significant improvements in the outcome of treatment of subtrochanteric fractures and a reduction in the frequency of complications. Nonetheless, there are still problems to be solved. Elderly patients who have low bone quality and limited compliance and strength and are dependent on full weightbearing benefit especially from intramedullary stabilisation of these fractures. The choice of implant and operative technique depends on the degree of instability in the individual fracture type.Subtrochanteric fractures are frequently combined with intertrochanteric fractures.The high degree of instability in such fractures makes their treatment particularly challenging.     

Osteosynthesen bei pertrochanteren Femurfrakturen

In terms of quality-adjusted life years, internal fixation is still accepted as the most appropriate treatment for pertrochanteric fractures of the femur in elderly patients.The aim of treatment in such patients is to restore them to the levels of mobility and social functioning they had before the injury as quickly as possible, but this is currently achieved in only about 25% of cases.Many implants have been proposed in recent years.At present, the proximal femoral nail seems to have various advantages in the treatment of fractures of this type,though the dynamic hip screw is still more widely used.     

213. Osteosynthesen bei Malleolarfrakturen

Zusammenfassung Bestimmte Unfallmechanismen erzeugen Knöchelbrüche und Bandläsionen verschiedener Schweregrade. Aufgrund von Standardröntgenbildern lassen sich die Malleolarfrakturen klassifizieren und operativ zielsicher behandeln. Therapeutische Priorität besitzt der Außenknöchel und die Syndesmose. Die operative Behandlung verfolgt die übungsstabile anatomische Wiederherstellung der Knöchelgabel und die Naht verletzter Ligamente. Dargestellt werden typische Osteosynthesen am Außenknöchel, am Innenknöchel, am Volkmannschen Dreieck und die Naht der fibularen Seitenbänder und die Versorgung einer rupturierten ventralen Syndeamose.

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Internal fixation of malleolar fractures

Summary Certain mechanisms produce typical malleolar fractures. A pathologic-anatomical classification allows recognition not only of the fracture elements, but also of the ligamentous damage. The film shows characteristic methods for internal fixation of the lateral and the medial malleolus and of a posterior lip fragment of the tibia, and for suturing of ruptured ligaments.

     

223. Osteosynthesen bei Vorderarmfrakturen

Ohne Zusammenfassung     

Risiko der posttraumatischen Osteitis bei Osteosynthesen

Posttraumatic osteitis following fracture treatment with fixation devices can be regarded as a risk not only for the individual patient but also for the insurance company concerned and finally for the treating surgeon. According to the current pathophysiological model, the traumatic damage to the bone and soft tissues, the extent and type of bacterial contamination and the presence of foreign body implants have to be regarded as the leading risk factors. In the literature the risk of infection following fracture treatment with fixation devices is quantified with the aid of very variously defined infection rates, which therefore vary substantially. Recent prospective multicenter investigations with sufficiently large numbers of cases point to infection rates of up to 5% following closed fractures, while the rates for compound fractures can be several times as high, depending essentially on the accompanying trauma. It is to be expected that the risk of osteitis following osteosynthesis will ultimately be further reduced only through strict application of risk-adapted, sequential and differentiated therapeutic surgical stategies.     

85. Strahlenbelastung bei percutanen Osteosynthesen

Zusammenfassung Bei 173 percutanen Osteosynthesen wurde eine mittlere Durchleuchtungszeit von 4,08 min pro Operation ermittelt. Die Strahlenbelastung des Operateurs beträgt im Mittel 1,37 mr pro min. Die Toleranzdosis liegt bei ca. 100 mr pro Woche. Rund 70 min Durchleuchtungszeit wären demnach zumutbar. Alle anderen Personen des Op.-Teams bleiben unter diesen Werten. Die Überwachung des Personals ist nach unseren Untersuchungen auf Operateur, Durchleuchtet, Instrumentenschwester zu beschränken.     

Indikationsfehler bei der Metallentfernung nach Osteosynthesen

Ohne Zusammenfassung     

Repositionstechniken bei Osteosynthesen von artikulären Frakturen

Die Unfallchirurgie - Die Eckpfeiler der Behandlung von Gelenkfrakturen sind einerseits der schonungsvolle Umgang mit den Weichteilen und andererseits eine anatomische Rekonstruktion der...     

Stabilitätsmessungen bei Osteosynthesen am proximalen Femur

Zusammenfassung In einer vergleichenden Untersuchung wurde die Biegebelastbarkeit stabiler und instabiler pertrochanterer und subtrochanterer Frakturmodelle nach Osteosynthesen am Knochenpräparat mit Y-Nägeln, Ender-Nägeln, 130°-Winkelplatten und 95°-Kondylenplatten der AO getestet. Bei den instabilen Bruchformen wurden auch Verbundosteosynthesen mit Knochenzement geprüft.Bei der stabilen Form der pertrochanteren Fraktur ist die Ender-Nagelung mit durchschnittlich 147 kp, die Winkeplatten-Osteosynthese mit ca. 200 kp belastbar.Bei fehlender medialer Abstützung gelingt eine hochbelastbare Osteosynthese mit den geprüften Methoden nur dann, wenn der Defekt am Adam'schen Bogen mit Knochenzement aufgefüllt wird.Die mit mehr als 300 kp belastbare Kondylenplatten-Verbundosteosynthese der instabilen per- und subtrochanteren Fraktur erwies sich bei einmaliger Belastung stabiler als die anderen getesteten Verfahren.Die Versuchsergebnisse sind synoptisch in Tabelle 4 zusammengefaßt.

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Measurements of stability of operative osteosynthesis on the proximal femur

Summary Bending burdening of stable and unstable per- and subtrochanteral fractures after osteosynthesis with Y-nails (Küntscher), Ender-nails, 130°and95° angled plates of the AO were tested in a comparative experimental study. The unstable fractures were also tested after treatment with osteosynthesis and additional application of bone cement in the artificial defect.The essential results were as follows: in the group of stable pertrochanteral fractures the Ender-nails bear in the mean 147 kp, the 130° angle plate 200 kp.In the fracture-group with lacking medial support a highly burdening osteosynthesis could only be achieved by filling up the defects with bone cement.The 95°-angled plate-osteosynthesis combined with bone cement bearing more than 300 kp was superior to the other procedures in the unstable per- and subtrochanteral fractures. In our investigation the stabilizing forces of muscles and fascia have not been taken into consideration.

     

Lassen sich Korrekturverluste bei winkelstabilen Osteosynthesen vermeiden?

The advantages of fixed-angle implants are due to the design of the screws used, which results in increased axial stability, only slight periostal contact, and better seating of the implant in bone that is already damaged. These implants can be used, for example, in the long bones, the spine and the pelvis. They can be applied for the treatment of joint fractures and fractures in the vicinity of joints, and also for the treatment of such problem fractures as those close to prosthetic implants. It is not always possible to avoid secondary correction loss. It is important to differentiate technical surgical errors, such as selection of the wrong implant with consequent implant failure, and impaired fracture healing with deformation of the implant from correction loss that is not dependent on the implant system at all. A sound introduction to the use of the system to be applied can keep correction loss to a minimum.     

Belastungsstabile Osteosynthesen mit Autopolymerisaten bei Knochenmetastasen des Femur

Zusammenfassung Diese unmittelbar postoperativ belastungsstabile Osteosynthese mit Palacos nach Entfernung der Knochenmetastase erfordert je nach Lokalisation verschiedene Operationsverfahren. Man erzielt damit die rasche Wiederherstellung der Gehf?higkeit und die Beseitigung der Schmerzen. Von 23 so operierten Patienten konnten bis auf 4 postoperative Todesf?lle alle gehend entlassen werden. 4 Patienten leben derzeit noch 10–32 Monate nach der Osteosynthese, zum teil ohne manifeste Metastasen.

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Summary Depending on the location, different surgical methods are required for osteosynthesis with plastic materials after removal of the bone metastasis. This osteosynthesis can be subjected to weight-bearing immediately after surgery. This procedure permits rapid reconstitution of the ability to walk and elimination of pain. With the exception of 4 postoperative fatalities all of the 23 patients operated in this manner could be discharged ambulatory. 4 of these patients are still alive 10 to 32 months after osteosynthesis, in part without obvious metastases.

     

Gefahren der Plattenosteosynthese bei Gelenk- und gelenknahen Frankturen der distalen Tibia

Ohne ZusammenfassungMit 5 AbbildungenVortragender:C. Herfarth-Marburg     

Grundsätze und Möglichkeiten der Physiotherapie bei gelenknahen Verletzungen

The principles and potential benefits of physiotherapy following injuries close to ¶the joints can be summarized as four treatment principles: (1) Treatment of the joints at each side of the fracture; (2) lowering of muscule tone; (3) mobilization of the connective tissue; and (4) improvement of the gliding processes in the joint affected. Ways of realizing each of these treatment principles are presented. The basic idea is to aim for early functional treatment. The physiotherapist needs knowledge of biomechanics, the ability to apply precisely tailored methods of treatment, and specific treatment guidelines. A good overall functional result as perceived by the patient is the ultimate goal.     

Maßnahmen bei fehlgeschlagenen Osteosynthesen am proximalen Femur

Trauma und Berufskrankheit - Fehlgeschlagene Osteosynthesen des proximalen Femurs lassen sich folgenden Problembereichen zuordnen: Implantatassoziierte Probleme beruhen meist auf...     

8. Die Dringlichkeit von Osteosynthesen bei der Erstversorgung kombinierter Verletzungen

Zusammenfassung Die Erfahrungen der letzten Jahre haben gelehrt, daß gerade bei den Mehrfachverletzungen der sofortigen, d. h. notfallmäßigen Stabilisierung von Frakturen eine mitunter lebensrettende Bedeutung zukommt. So spielt die Osteosynthese hinsichtlich der Dringlichkeit im Rahmen der Erstversorgung eine bedeutsame Rolle. Die Möglichkeit, durch eine sofortige innere Fixation den Knochenbruch ohne zusätzliche äußere Hilfsmittel wie Gips- oder Streckverbände zu neutralisieren, unterstützt alle modernen intensiv-therapeutischen Maßnahmen. Neben der unmittelbar vitalen Indikation zur Osteosynthese, die unter dem Blickwinkel der Schock- und damit der Fettemboliprophylaxe, der Versorgung von peripheren Gefäßverletzungen in Kombination mit einem Knochenbruch, der Behandlung von Knochenbrüchen bei alten Menschen und anderem zu betrachten ist, muß auch die Indikation zur Verbesserung der Pflegefähigkeit der Verletzten mit schwe-ren Schädel-Hirntraumen, gelegentlich auch bei schweren Nervenläsionen, die mit Knochenbrüchen kombiniert sind, im Rahmen der Erstversorgung Berücksichtigung finden.Es läßt sich verständlicherweise kein starres Schema aufstellen. Für jeden Einzelfall wird man unter Berücksichtigung des genauen Verletzungsbildes und des Allgemeinzustandes des Patienten in Übereinstimmung mit dem Anaesthesisten und allen zuständigen Fachkollegen die Reihenfolge im Ablauf der Erstversorgung festlegen müssen. Nur einer absolut stabilen Osteosynthese kann in diesem Zusammenhang Bedeutung zukommen.

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The urgency of osteosynthesis

Summary The experience of the last few years has taught us that in multiple injuries the immediate immobilization of fractures in an emergency can, under certain conditions, save lives. Osteosynthesis, therefore, plays an important part in urgent primary surgical care. The ability to immobilize a broken bone by immediate internal fixation without additional external measures like P.O.P. or traction, is an aid to all other modern intensive therapeutic measures. In addition to the immediate and vital indications for osteosynthesis, which include the prevention of shock and fat embolism, the repair of peripheral vascular injuries in connection with fractures, the treatment of fractures in old people, one should also consider that it makes the care of patients with severe cranial and cerebral traumas or other severe nerve injuries who also sustained fractures much easier. It should, therefore, be born in mind within the framework of primary surgical care.A rigid procedure is obviously not suggested. In each individual case one has to consider the extent of the injuries carefully and the patient's general condition and decide after consultation with the anaesthetist and all other responsible colleagues in what sequence the primary surgical measures should be carried out. Only an absolutely stable osteosynthesis can in this connection be of any use.

     

Perfektionsimus oder Praktikabilität bei Osteosynthesen—Grenzen der Sorgfaltspflicht

The discussion of these complexe themas can only partially try to show the way to successful osteosynthesis for not only the patient as also for traumatologists and orthopedic surgeons. “Perfection or practicability”—this question is to be answered so that exaggerated perfection, as seen overall in surgery, is not foundation of the successful result. On the contrary, osteosynthesis procedures conceived so that they are generally practicable and employable for those colleagues who are experienced and have confidence with the material. Perfection should not be isolated as bare organ surgery. At the same time it is clearer that it is not possible to stop the specialization in bone surgery. In its place arises the necessity of an interdisciplinary cooperation of all surgical specialities. These demands will justify our current concept of treatment under the condition that the surgeon realizes his limitations in difficult situations and behaves accordingly. Practicable and even to perfection is however the relationship of the bone surgeon to the patient who is injured in an accident. The professional assessment of the true or the apparent failures after osteosynthesis must observe the written laws. Mistakes, which reveal the ignorance and which grossly contradict the limiting prerequisites of the guidelines for the execution of osteosynthesis are to be appraised as such. The professional consultant, himself, must be so confident with the practice of osteosynthesis so that he can implement an objective and critical estimation of the situation. A too favourable assessment with pardon of all the mistakes and laying the blame on the particularity of the injury, on the situation, or even laying the blame on the patient's behaviour, is just as wrong as the application of exaggerated, and sometimes not realistic measures. A sensible decision which is adapted to the problems should be the aim of the professional judgment and sets the frontiers of the obligations of care and management. Only in this manner can the often repeated reproach “a crow does not pick out the eyes of another crow” be invalidated.     

Der Aussagewert des Röntgenbildes bei der Beurteilung von Osteosynthesen

European Journal of Trauma and Emergency Surgery - Auf die entscheidende Bedeutung des Röntgenbildes bei der Beurteilung von Osteosynthesen im Hinblick auf die Belastbarkeit wird hingewiesen....