Lateral approach to the orbit: An anatomical study

The authors have identified and described three lateral approaches to the intraorbital portion of the optic nerve in cadavers. The structures exposed via the superior, inferior or central approaches were directed through the lateral orbital wall. The superior approach in which the lateral rectus muscle is retracted inferiorly exposes the superolateral aspect of the orbit. The inferior approach in which the lateral rectus muscle is retracted superiorly, provided the inferolateral aspect of the optic nerve from the globe to the muscle cone. The central approach in which the lateral rectus muscle was disinserted and retracted provided excellent exposure of the structures of the lateral part of the orbit and the optic nerve. There were no structures blocking access to the ciliary ganglion and two third anterior optic nerve and lateral surface of the globe. The structures encountered in these approaches are demonstrated under magnification in cadavers, and the exposure of the optic nerve is discussed.     

Medial microsurgical approach to the orbit: an anatomic study.

The authors have identified and described three medial approaches to the intraorbital portion of the optic nerve in cadavers. The structures exposed via the superior, inferior or central approaches were approached through the medial orbital wall. The superior approach in which the medial rectus muscle is retracted inferiorly exposes the superomedial aspect of the orbit. The inferior approach in which the medial rectus muscle is retracted superiorly, provided the inferomedial aspect of the optic nerve from the globe to the muscle cone. The central approach in which the ethmoidectomy was performed and the medial rectus muscle was disinserted and retracted, provided excellent exposure of the structures of the medial part of the orbit and the optic nerve. There were no structures blocking access to the two third anterior optic nerve and medial surface of the globe. The structures encountered in these approaches are demonstrated under magnification in cadavers, and the exposure of the optic nerve is discussed.     

Traumatic hip luxation associated with ipsilateral and contralateral femoral fracture in a child

In children, the association of traumatic luxation of the hip with homo- and heterolateral fracture of the upper extremity of both femurs, is extremely rare. In the case reported here, that association is present. Hip luxation can easily pass unrecognized. Orthopedic reduction is always recommended. Regarding the fracture of the upper portion of the femur in children under 10 years, when alignment of the fragments is not well achieved, surgical treatment should be considered. In this case, valgus osteotomy had to be performed in order to correct a post-traumatic coxa vara. After 4 1/2 years of follow up, the only sequel was a 1 cm leg-length discrepancy.     

Die isolierte Luxation im distalen Radioulnargelenk

Anatomy, injury-mechanism and classification will be illustrated with a casuistry of the rare isolated luxation of the ulnar head. Diagnosis is established clinically and with comparative X-rays. In our case the luxation was irreponible in general anaesthesia and had to be succeeded by open reposition with temporary pin-fixation. Postoperatively a cast up to the upper arm is necessary for six weeks. With the removal of the plaster also the pinwires immediately have to be withdrawn, as to evade complications like fatigue-breakage of the implanted material. With adherence to this therapeutic scheme operative treatment is unproblematic and—by means of posttraumatic physical therapy—shows a good functional result.     

A New Technique for Levator Lengthening to Treat Upper Eyelid Retraction: The Orbital Septal Flap

Correction of upper eyelid retraction can be achieved by numerous techniques. We have developed a new flap, the orbital septal flap, to interpose between the recessed levator complex and the tarsus to correct the retracted upper eyelid of a young girl. The orbital septum is a facial structure; it is readily available and easy to dissect. The flap acts like a vascularited spacer without the problem of resorption; normal anatomical continuity of the levator mechanism can be functionally restored. We believe the orbital septal flap is a promising technique for correcting upper eyelid retraction; however, more case studies are needed.     

Pericardial tamponade: an unusual complication of lobectomy for lung cancer.

A rare case of pericardial tamponade developed in a 69-year-old man after a right upper lobectomy for lung cancer. This unusual complication presented in the early postoperative period and was associated with what we believed to be an aberrant right bronchial artery coming off the intrapericardial portion of the aorta. This vessel retracted into the pericardial sac where it bled causing a pericardial tamponade.     

Posttraumatic recurrent luxation of knee joint (author's transl)

A posttraumatic, recurrent luxation of the knee joint is presented. The cause for the first luxation was a severe trauma. As the treatment of the ligament and capsule ruptures of the first luxation was inadequate, the effect was a completely unstable knee joint. By hyperextension trauma or hyperextension following weakness of the muscles of the thigh recurrent luxations of the knee were caused. The importance of a sufficient treatment of ligament and capsule damage following a knee luxation is emphasized.     

Extensile posterior approach to the radius

An extensile posterior approach to the radius was studied on 20 forearm anatomic specimen upper limbs. The skin incision followed a line from the lateral epicondyle of the humerus to a point corresponding to the middle of the posterior aspect of the wrist. Dissection was done between the extensor digitorum communis and the extensor carpi radialis brevis. The posterior interosseous nerve was identified, and the muscle fibers of the superficial head of the supinator were divided from distal to proximal to the posterior interosseous nerve, which was dissected and carefully retracted laterally. The muscle fibers of the deep head of the supinator were divided to the bone. An incision was made along the superior and inferior margins of the abductor pollicis longus and extensor pollicis brevis. A nerve tape was placed around the two muscles, and they were retracted proximally and medially or distally and laterally, as necessary. To expose the distal third of the radius, the obliquely placed muscles, abductor pollicis longus, and extensor pollicis brevis were retracted proximally and medially. Dissection was done between the extensor carpi radialis brevis and extensor pollicis longus. Anatomic study of the posterior interosseous nerve branches was done to understand the vulnerability of such branches seen in this approach.     

Zur konservativen Therapie der Schulterluxation

There is no undivided agreement in how long a shoulder ought to be fixed after a luxation. Having made a distinction between the terms of habitual and posttraumatic recidivous luxation of the shoulder, the results of a retrospective analysis of 118 luxations of the shoulder are shown, with 75 outpatients after a primary luxation. In most cases the fixation in the Desault-dressing was maintained for three to four days and was followed by early-functional physiotherapeutical after-treatment. Ten patients=14.9% developed posttraumatic recidivous, and eight patients=10.4% habitual luxations. In comparison with other analyses, these results show that with a short time of fixation of three to four days there is no higher tendency to reluxation than with a longer time of fixation. If a habitual or a posttraumatic recidivous luxation occurs, operative treatment is required.     

Patellar dislocation. Diagnostic and forensic problems]

Very often, patellar luxation or subluxation after spontaneous setting is difficult to diagnose. Concomitant injuries can be highly misleading during diagnosis. Traumatic luxation almost always results from forces exerted on the knee indirectly and by way of the muscles, and must be differentiated from habitual luxation. When the constitution favors the occurrence of luxation it is not the clinical and radiological results that are relevant to the assessment. Only an exact analysis of the course of events can clarify whether the trauma can be recognized as a basic cause covered by insurance laws.     

肘部尺神经卡压与尺神经半脱位的诊疗进展

肘部尺神经卡压也称为肘管综合征,可造成手部一系列功能障碍,是最常见的上肢神经卡压症之一。尺神经脱位及半脱位为尺神经卡压的影响因素。尺神经卡压按McGowan分级分为Ⅰ、Ⅱ、Ⅲ级。Ⅰ级首选保守治疗 Ⅱ、Ⅲ级保守治疗效果欠佳,多需要手术治疗。手术方式主要有尺神经原位松解术（包括肱骨内髁切除术）、粘膜下尺神经前置术、肌下尺神经前置术及肌内尺神经前置术等,其中原位松解手术操作相对简单,但对于尺神经卡压伴有尺神经脱位者多属禁忌,应首选尺神经前置术。     

Fractures of the upper end of radius and ulna and recent dislocations of the elbow in children

In this report concerned with luxation of the elbow and fractures of the upper end of two forearm bones in children emphasis is placed on the importance of the initial treatment, since sequelae are not corrected during growth. Correct therapy requires firstly a precise diagnosis, this depending on the obtaining of images of very good quality, if necessary taken during sleep if the child has to be anesthetized. Therapy should be as atraumatic as possible, particularly in the region of the head of radius, to avoid its subsequent necrosis.     

Functional outcome after hand and forearm transplantation: what can be achieved?

The first successful hand transplant in the modern era of reconstructive transplantation was performed in 1998. Since then, more than 65 hand and upper limb transplantations have been performed around the globe, with encouraging results. The main goal of all upper limb transplantations is to enhance the patient's quality of life. The transplant must be successfully integrated into the patient's body and self-image and the recipient should be satisfied with the recovery of sensitivity and muscle function of the new limb. To achieve these goals, a proper and thorough design of the rehabilitation regimen is of critical importance.     

Experimental study for clarification of the pathogenic mechanism in traumatic peroneal tendon dislocation

An experimental trial was performed to illustrate the causative mechanism of peroneal tendon luxation. It seemed that traumatic luxation of the peroneal tendons was found to originate in dorsiflexion, abduction and eversion of the forefoot. On the other hand, unless the peroneal muscles are at high tension and the ankle joint supported with a high shoe or similar a trimalleolar ankle fracture is likely. The depth of the retromalleolar groove is only one more factor predisposing to luxation of the peroneal tendons.     

Chain-saw facial injuries.

Accidents caused by kickback from chain saws produce facial injuries with consistent features. These features include oblique, destructive, ragged lacerations of the left side of the face. Although eyelid damage may be severe, damage to the globe itself is minimal. An analysis of 10 such accidents revealed this consistent pattern. Of this group, eight injuries were left-sided and six involved mainly the eyelid and adjacent structures. Only one patient was left with permanent damage to the globe and with slightly impaired (20/60) vision. The upper lid was always more severely damaged than the lower. The author discusses the merits and disadvantages of protective devices for both operator and machine.     

'Lacricele'--an unusual case of proptosis

A patient who sustained a penetrating injury to the right upper lid and eyeball presented a year later with a large cystic swelling in the orbit, which had caused proptosis and displacement of the globe. A symblepharon was found to have walled off the upper fornix causing lacrimal secretions to accumulate, thus forming a cystic lesions or lacricele.     

Volar scaphotrapezial dislocation.

We present a case of volar luxation of the scaphotrapezial bone, in which radiographs suggested luxation of the scaphoid, but unclear relations to the other carpal bones. Computer tomographic reconstruction showed an isolated scaphotrapezial luxation. This was treated by closed reduction and a plaster cast, after which the patient regained normal function of her wrist.     

Volar scaphotrapezial dislocation

We present a case of volar luxation of the scaphotrapezial bone, in which radiographs suggested luxation of the scaphoid, but unclear relations to the other carpal bones. Computer tomographic reconstruction showed an isolated scaphotrapezial luxation. This was treated by closed reduction and a plaster cast, after which the patient regained normal function of her wrist.     

Technique for Correction of the Retracted Columella, Acute Columellar-Labial Angle, and Long Upper Lip

The excess tissue from upper lip vertical length reduction provides bulk for opening the columella–labial angle and increasing the visibility of the columella and upper lip vermillion. Decorticated centrally based transverse flaps from the lip and nostril floor, when transposed into a columellar pocket, correct commonly combined degenerative or developmental deformities. The technique delivers premaxilla, columella, and columella–labial angle mass, which simultaneously corrects the retracted columella, opens the columella-labial angle, shortens the upper lip length, and enhances vermillion visibility.     

Posttraumatische Trachealstenose nach komplexer HWS-Fraktur

Combined injuries of the upper cervical spine are rare and can lead to life-threatening positional changes of the respiratory tract. Hence, it is very important to recognize tracheal and soft tissue injuries and to treat these adequately. We report on the clinical course and outcome of a case with a delayed high-grade tracheal stenosis after cervical spine injury, which could only be treated by emergency tracheotomy and partial transverse trachea resection. The 25-year-old female suffered a complex dislocated upper cervical spine fracture with a Jefferson fracture, an odontoid fracture and a dislocated C6/7 luxation fracture after a motor vehicle accident. Immediately after trauma inspiratory stridor was reported. Postoperatively, the tracheal stenosis increased and the histological examination of tissue collected during emergency bronchoscopy showed granulation tissue. Even if fractures of cervical spine injuries are treated successfully, soft tissue and tracheal injuries cannot be precluded. Therefore, it is most important that such patients are followed-up closely to classify the problem and to determine the ideal time for surgical treatment of tracheal injuries and stenoses.