Suprakondyläre Femurfraktur bei Kniearthrodese

We present a 65 year old patient who complained of pain in the right supracondylar femur region after minor trauma. He previously underwent arthrodesis of the knee and had had several operative treatments for a septic hip endoprosthesis on the same side. The MRI showed a fracture of the supracondylar femur, which was successfully treated by partial intra- and extramedullary minimal invasive osteosynthesis.     

Suprakondyläre Humerusfraktur bei Kindern

Trauma und Berufskrankheit - Die suprakondyläre Humerusfraktur macht etwa 4–7% aller Frakturen im Kindesalter aus. Sie ist die häufigste knöcherne Ellenbogenverletzung im...     

Suprakondyläre und subkapitale Humerusfrakturen

Osteochondral lesions can be found in joint surfaces and affect the cartilage covering, in particular also the subchondral bone layer. During pressure stress on the joint surface the laws of force parallelograms apply which lead to resulting injuries of the joint surface. Damage caused in this way can result in osteoarthritis if the healing process is prolonged but can also occur due to disease or overuse. Necrosis (osteonecrosis) in the subchondral region results from fractures, spontaneously for idiopathic reasons, as a result of underlying diseases, due to risk factors and as damage to the growing skeleton resulting in osteochondrosis dissecans (osteonecrosis). This can also result in osteoarthritis as it also promotes osteochondrosis.     

Suprakondyläre Femurfrakturen bei Knieendoprothesen Stabilisierung mit einem retrograden Verriegelungsnagel

The treatment of supracondylar fractures of the femur in total knee arthroplasty is still challenging, and a variety of methods has been recommended. In a retrospective analysis, we reviewed six patients (average age: 70.5 years) with this type of fracture that had been stabilized with a retrograde intramedullary locking nail [Green-Seligson-Henry (GSH) nail]. The fracture had occurred 34.5 months after implantation of total knee arthroplasty. The average time of the operation was 97.16 min. There were no intra- or postoperative complications. All patients could be followed up at 17.3 months on average. Fracture healing was uneventful in all six cases. The postoperative range of motion was similar to the prefracture level in five patients. One patient demonstrated a loss of extension (10 degrees) associated with a valgus malalignment of 10 degrees. According to our experience, retrograde intramedullary nailing of supracondylar fractures in total knee arthroplasty is a promising alternative, which allows closed reduction and preservation of the soft tissue envelope. Immediate mobilization with partial weight bearing is possible, and the rate of complications is low.     

Suprakondyläre Extension einer pertrochantären Femurfraktur bei einem Patienten mit Unterschenkelamputation

Zusammenfassung Die pertrochantäre Femurfraktur bei unterschenkelamputierten Patienten ist ein seltenes Ereignis. Mit Hilfe der suprakondylären Extension können die Vorteile des Extensionstisches voll genutzt werden. Die intraoperative Versorgung mit einem Steinmann-Nagel ist ein bekanntes risikoarmes Verfahren zur Durchführung einer Frakturextension. Diese Art der Extension stellt unserer Ansicht nach bei der postoperativen prothetischen Versorgung eines unterschenkelamputierten Patienten kein Problem dar.     

Interdisziplinäre neurovaskuläre Netzwerke

The regional and national stroke units in Germany are the basis for a highly developed and comprehensive stroke treatment service. Whereas the majority of stroke patients are treated on stroke units certified by the German Stroke Society (DSG), a minor proportion of patients with acute stroke are candidates for novel methods of treatment, which are only available in highly specialized clinics. These modern neurointerventions using microcatheters and neurosurgical treatment methods require specialists who cannot be retained in every hospital; therefore, it is necessary to form a network, which can direct these patients to a specialized center. The DSG initiated a pilot project in 2013 to establish interdisciplinary neurovascular networks (INVN), which provide a national treatment coverage of all neurovascular diseases and create a treatment structure, which guarantees nationwide availability of modern therapies for all patients. The concept of INVN is based on the fact that the complexity of neurovascular diseases necessitates close cooperation between neuroscientific faculties, including neurology, neurosurgery, neuroradiology and other disciplines, such as cardiology and vascular surgery. After a successful pilot phase with subsequent evaluation by auditors of the specialist societies, the DSG, the German Society of Neuroradiology (DGNR) and the German Society of Neurosurgery (DGNC), the next step involves certification with the aim to establish and adhere to quality criteria in a verifiable way and to guarantee the structural prerequisites for a high-quality treatment service.     

Muskuläre Biomechanik in der Sprunggelenkprothetik

The purpose of this orthopaedic-biomechanical study was to evaluate the muscle function in total ankle replacement (TAR) patients 1 year after surgery. Ten patients underwent a combined clinical and muscle biomechanical assessment prior to implantation and at the 1-year follow-up. Pain score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, ankle range of motion (ROM), and calf circumference difference between the affected leg and contralateral healthy leg were assessed. Biomechanically, isometric maximal voluntary torque for ankle dorsiflexion and plantar flexion was measured simultaneously with surface electromyography of four lower leg muscles.At follow-up, a significant improvement of the pain score (from 6.7 to 0.8 points), AOFAS ankle score (from 35.6 to 92.3 points), and ROM could be shown. Not significantly, the mean calf circumference difference between legs decreased from 2.2 to 1.4 cm. However, a significant increase was seen in the mean dorsiflexion (from 17.0 to 25.8 Nm) and plantar flexion torque (15.7 to 24.6 Nm) of the TAR-treated ankle. The mean EMG frequency content of the affected lower leg at TAR follow-up was lower than in the muscles of the contralateral healthy side. In contrast, the mean EMG intensity at TAR follow-up in side-comparison was statistically the same for all muscles.Ankle OA patients have better muscle function with TAR than under the arthritic condition, but they do not reach the normal level of the contralateral healthy leg 1 year after surgery.     

Stationäre Thrombembolieprophylaxe in der Unfallchirurgie

The presented thromboprophylactic concept includes weight bearing and ankle motion as well as breathing therapy and drug prophylaxis (antiphlogistics, analgesic drugs, heparin). Routinely performed ultrasound screening of the deep veins (legs and pelvis) before release showed a low DVT incidence of 2.5% in a prospective clinical observation of 841 inpatients. Obesity, venous insufficiency, and a history of previous thromboembolic events were associated with a significantly increased risk of thrombosis (relative risk 4.1, 4,9, and 5.8, respectively) The duration of immobilization also had a relevant influence indicating that early postoperative physiotherapy in traumatology and orthopedic surgery has a widely underestimated thromboprophylactic effect.     

Spondyloepiphysäre und metaphysäre Dysplasie

Spondyloepiphyseal, metaphyseal and spondylometaphyseal dysplasias are a group of hereditary skeletal diseases, which lead to small stature, axial deformities of the lower extremities and spinal deformities. They differ in pathophysiology, heredity and in their clinical and radiologic appearance. The orthopaedic surgeon treats the spinal manifestations and the axial malalignment of the disease. Among the spinal deformities there are instabilities of the upper cervical spine as well as structural deformities like kyphosis and scoliosis. More frequently, the axial malalignment caused by congenital coxa vara, severe genu varum or genu valgum requires treatment. These deformities are managed by corrective osteotomies of the proximal femur, supracondylar or proximal tibial osteotomies around the knee and by temporary epiphyseodeses. Despite a high recurrence rate requiring repeated surgery the patients report great satisfaction with the treatment results. Well-timed orthopaedic treatment helps avoid or delay the inevitable long-term sequelae of untreated patients such as painful degenerative changes of the spine or early onset of severe osteoarthritis.     

Ultraschallgesteuerte perivaskuläre axilläre Plexusanästhesie

BACKGROUND: The perivascular axillary plexus block is an easily applicable procedure with a low risk of complications but with a high failure rate. To improve this, the standard procedure was combined with transpectoral sonography to benefit from the advantages of ultrasound, while using a nearly unchanged puncture technique. METHOD: The technique developed by the authors is described in this article and the success rate and the time factor were determined in a sample of 86 patients. The success rates were compared to previous rates without ultrasound and to those in the literature. RESULTS AND CONCLUSIONS: The rate of complete blocks without the use of transpectoral sonography in our clinic and in the literature was approximately 72%, whereas using transpectoral ultrasound it was 96.5%. None of the 86 patients with transpectoral sonography required general anaesthesia. The onset time using transpectoral sonography was approximately 6 min. The perivascular axillary plexus block, combined with transpectoral sonography, is an effective and efficient procedure.     

Linksventrikuläre Projektilmigration nach akzidentiellem Schrotschuss aus nächster Nähe

We report the case of a 24-year-old female after sustaining a shotgun wound in the left upper extremity and chest. Initial emergency diagnostics revealed numerous shotgun pellets scattered throughout the left-side soft tissue, chest and upper lung lobe with one pellet having migrated into the left ventricle of the heart.     

Endovaskuläre Eingriffe in der interventionellen Neuroradiologie

In the last 10 years interventional neuroradiology has become established especially in the endovascular treatment of aneurysms as the preferred treatment according to level 1 evidence and more recently in the treatment of acute ischemic stroke. These interventions are performed as routine procedures in an increasing number of centers. This, however, necessitates that anesthesiologists and neuroradiologists become increasingly more familiar with the complementary expectations and potential pitfalls in working together to maximise efficiency and patient safety. As a further challenge there are different aspects to be considered in elective procedures and emergency procedures where time is brain. This article highlights these aspects for the two most common procedures: aneurysm treatment and multimodal recanalization treatment for acute ischemic stroke.     

Die intraossäre Punktion in der präklinischen Notfallmedizin

INTRODUCTION: The intraosseous puncture (IO) is a fast and safe alternative to the puncture of peripheral veins in emergency situations in children < or =6 years of age. The purpose of this paper is to summarize 10 years of experience on the prehospital use of the IO method by the Helicopter Emergency Medical Service (HEMS) "Christoph 22", Ulm. MATERIALS AND METHODS: This was a retrospective study from 1 January 1996 to 31 December 2005. RESULTS: Out of a total of 9,549 missions, the proportion of children was 11.1%. In 27 children (4.2% of the children < or =6 years of age) an IO puncture was performed. Patients of the IO group were younger (1.0 vs. 3.7 years of age; p<0.001) and showed a higher degree of injury severity (NACA 6 vs. 4; p<0.001) compared to the total children group. In all children of the IO group (100%), the intraosseous puncture was the method of first choice to obtain access to the vascular system by the HEMS team. In 96.4% of these cases (26/27), the first IO puncture attempt was successful - in one child, a second puncture attempt was necessary. A standardized puncture technique was performed using the proximal tibia. The time required for successful placement of the IO infusion line was 60 s or less in all cases. In 37% of the cases (10/27) the IO infusion line was used for induction of general anaesthesia; dosage and onset of administered drugs were described as being equivalent to a peripheral infusion line. In all cases, the IO needle was replaced in-hospital within 2 h by a central or peripheral iv line. No complications were observed. CONCLUSIONS: The IO infusion technique is a simple, fast and safe alternative method for emergency access to the vascular system in children < or =6 years of age in the prehospital setting.     

Intramedulläre Oberarmverlängerung

The new technology of motorized intramedullary telescopic nails has simplified the treatment for upper limb lengthening surgery. Improved patient comfort, low infection rates and absence of fractures in the regenerated bone are contrasted by the limitations of the methods, such as a current maximum distraction of 5cm and the fact that they cannot be used when the growth plates are still open.