Neuralgie des N. genitofemoralis nach Hernioplastik

The peripheral nerve stimulation (PNS) is an established therapy in the management of neuropathic pain. Here, we describe a case of successful epifascial stimulation in the proximity of the genitofemoral nerve, which was injured during an endoscopic hernioplasty. During the following months the patient developed an intense neuropathy of this nerve, which we now treated by permanent PNS with an 8-polar electrode. During the 1 year follow-up the patient described a pain reduction of nearly 70%. There were no adverse events until now. In conclusion, PNS is a promising procedure in the treatment of neuralgia after hernioplasty.     

Endoskopische Dekompression des N. ulnaris beim Kubitaltunnelsyndrom

Aim

The purpose of this study was to evaluate the results after endoscopic decompression of the ulnar nerve and to assess whether the results are comparable to open decompression.

Method

A total of 24r patients with clinically and electrophysiologically proven cubital tunnel syndrome were treated by endoscopic decompression. The ulnar nerve was visualized via a 2 cm incision in the sulcus area. Distal (up to 15 cm distal from the elbow joint) and proximal (up to 10 cm proximal from the elbow joint) decompression was performed endoscopically. An anterior transposition of the nerve was not necessary in any patient. Patients were examinedclinically and electrophysiologically after 3, 6 and 12 months and Dellon’s classification and the modified Bishop score were used to evaluate the patients.

Results

Of the patients 22 could be completely evaluated and all patients showed improvement of the preoperative complaints. The results of the modified Bishop score revealed that14 patients showed very good results, 7 good and 1 satisfactory at the last follow-up. One superficial hematoma was noted postoperatively and21 patients were satisfied with the postoperative results and would choose this surgery again.

Discussion

Endoscopic decompression of the ulnar nerve in cubital tunnel syndrome is a minimally invasive method with high acceptance and a high level of safety and it is therefore a safe alternative method to simple open decompression.     

Distale Ulnafraktur als Begleitverletzung des körperfernen Speichenbruchs

The distal radius is one of the commonest sites of fracture, and this injury is sometimes associated with fracture of the distal ulna. In recent years, surgical treatment of distal radius fractures has consisted increasingly in internal fixation with locking plates followed by early functional postoperative treatment. The associated injury to the distal ulna has so far not received much attention in the literature. Various techniques have veen described for its treatment: Kirscher wire fixation, tension band wiring, and internal fixation with screws and plates. Following positive results with elastic stable intramedullary nailing (ESIN) in the treatment of shaft fractures in children this technique was also applied in in fractures in adults (forearm, clavicle). Use of this technique for stabilisation of distal ulnar fractures has not previously been reported. In the course of a prospective longitudinal study (EBM level II), in 26 patients with an average age of 73.6 (42-88 years), bone healing in anatomical position was achieved in all cases within 6-12 weeks after closed reduction and anterograde ESIN with subsequent treatment that did not involve immobilization. No length differences of more than 2 mm and no functionally relevant deviations of the ulnar axis were observed. Apart from 3 cases of nail perforation at the distal end of the ulna, which had no clinical manifestations, there were no complications. ESIN offers a minimally invasive option for the treatment of unstable fractures of the distal ulna associated with distal radius fractures; it allows functional aftertreatment and can be regarded at least as an alternative to open reduction with internal fixation.     

Über Schädigungen des Nervus ischiadicus bei Schaftbrüchen des Oberschenkels

Zusammenfassung Es werden 3 F?lle von Schaftbrüchen des Oberschenkels beschrieben, von denen der erste eine vollst?ndige Durchtrennung des N. ischiadicus mit Bildung eines Neuroms an der Unterbrechungsstelle, der zweite eine nach Quetschung und Narbendildung im perineuralen Gewebe aufgetretene L?hmung des peronealen Anteils des Nerven, der dritte eine durch Verwachsung des Nervenstammes mit dem Callus bedingte Ischialgie aufwies. Es wird darauf hingewiesen, da? solche Sch?digungen des N. ischiadicus infolge der engen r?umlichen Beziehungen des Nervenstammes zum Knochen insbesondere bei Brüchen auftreten k?nnen, die etwa an der Grenze des mittleren und unteren Oberschenkeldrittels liegen. Daher mu? die für diese Bruchform typische Verschiebung des unteren Bruchstückes nach hinten unbedingt behoben werden. Die F?lle 1 und 2 wurden in der Freien Vereinigung der Chirurgen Wiens in der Sitzung vom 17. 1. 35 vorgewiesen.     

Proximale und distale Ruptur des M. biceps brachii

Ruptures of the biceps tendon account for a high percentage of tendon ruptures. The aetiology of proximal ruptures of the long head of the biceps tendon is often degenerative and they are frequently associated with lesions of the rotator cuff. The clinical findings are often not specific and long lasting. Distal ruptures of the biceps tendon mostly occur during eccentric contraction of the biceps muscle.Clinical tests, the associated haematoma and a distalisation or proximalisation of the muscle belly in combination with ultrasound or MRI to rule out combined diseases lead to the diagnosis. The possible options include conservative and operative treatment. Tenotomy and tenodesis lead to comparable results in the literature. Therefore, conservative treatment is mostly recommended in proximal ruptures. Operative treatment is preferred in distal ruptures of the biceps tendon in order to achieve an anatomical reconstruction of the muscle function. Chronic ruptures of the distal biceps tendon can be successfully treated with free autografts or allografts.     

Rekonstruktion der Schulterabduktion durch Transfer des M. trapezius

Introduction

After brachial plexus injuries, shoulder function is frequently impaired or lost. For reconstruction of the most important functions muscle transfers are indicated. To restore abduction and external rotation of the shoulder the trapezius muscle transfer is mainly used.

Patients and methods

We demonstrate 16 patients with insufficient abduction of the shoulder joint. All patients were treated with the transfer of trapezius muscle (pars horizontalis). We used a modification of the technique of Saha. After the operation, the arm was immobilized in 80° abduction for 6 weeks followed by 10° adduction of the shoulder per week. Afterwards physiotherapy was started. Evaluation was done by the DASH score and Gilbert score.

Results

In all cases, an improvement of shoulder mobility was seen, assessed clinically and individually by the patient. The average DASH score was 37.4. For ten patients the results of the operation were very good, good, or satisfactory. Active abduction increased from 15° (0–30°) to 54° (35–80°) postoperatively. The external rotation was 9° (?20–40°) preoperatively and 19° (0–70°) postoperatively.

Discussion

Trapezius muscle transfer for reconstruction of abduction is an easy and practicable method without serious complications. We achieved good stability and functionality of the shoulder. Intensive pre- and postoperative physiotherapy may provide greater improvement of mobility.     

Distale Humerusfraktur beim ?lteren Menschen

The intraarticular fracture of the distal humerus in an elderly patient remains a challenge for trauma surgeons. In case of severe co-morbidities and/or osteoporosis stable fixation with screws and plates is difficult and in some cases can be impossible. Even if osteosynthesis is feasible the clinical outcome is still incalculable due to delayed or non-union of the fracture fragments. Endoprosthetic replacement of the elbow joint for comminuted distal humerus fractures has been used for almost 20?years. The clinical results are predominantly excellent or good and better predictable than those of osteosynthesis. There still is no guideline when a prosthesis for the elbow joint should be used. We reviewed the literature and outline the current recommendations for diagnostics and surgical therapy for distal humerus fractures in the elderly.     

Ist die Blockade des N. cutaneus femoris lateralis eine Alternative zu einer klassischen Femoralisblockade bei Kniegelenkarthroskopien?

BACKGROUND: Gaps in the distribution area of the lateral femoral cutaneous nerve (LFCN) are assumed to be the reason for pain caused by a thigh tourniquet when performing a femoral nerve (FN) block according to Winnie. The aim of the study was to evaluate if a direct single blockade of the LFCN in patients undergoing knee surgery resulted in a better tolerance to the tourniquet with equally good analgesic quality during surgery. METHODS: A total of 40 patients undergoing knee arthroscopy received a proximal blockade of the sciatic nerve and randomly either an FN or an LFCN block. Practicability, onset time, quality of sensory and motor block, and clinical effectiveness during tourniquet and surgery were assessed. RESULTS: Stimulation time was significantly longer in the LFCN than in the FN group. Quality of sensory and motor block was worse in the LFCN than the NF group. Of the LFCN patients 65% indicated troublesome paraesthesia or pain when a tourniquet was placed, compared to 35% of the FN patients. Of the LFCN patients 50% had pain during cutaneous incision, compared to none of the FN group. During the course of surgery, 70% of the LFCN patients needed supplemental systemic analgesia, but this was required by only 30% of the FN group. CONCLUSION: An LFCN block is not a suitable alternative to an FN block for regional anaesthesia. For patients with contraindications for an FN block according to Winnie (e.g. vessel surgery in the groin) other more effective methods are available.     

Über vollständige Zerreißung des Nervus ischiadicus bei subkutaner Oberschenkelfraktur

Ohne Zusammenfassung     

Ultraschallgezielte Anlage eines Schmerzkatheters am N. medianus am Unterarm

The use of ultrasound is a fast growing area of regional anesthesia and pain medicine in practice and research. The technique of ultrasound-guided nerve block enables the visualization of peripheral nerves in the forearm and the insertion of a catheter for pain therapy. In a 37-year-old female a pain catheter was placed next to the median nerve. Ultrasound was used to visualize the nerve and to confirm correct catheter positioning and allowed extensive and painless early physiotherapy following arthrolysis and tenolysis of the flexor tendons.     

Distale Femurfraktur – State of the Art

Trauma und Berufskrankheit - Die distale Femurfraktur gehört zu den seltenen Verletzungen des Oberschenkels. Diese kann bei jungen Patienten durch ein Hochrasanztrauma und bei älteren...     

Tomakulöse Neuropathie (HNPP) als Ursache einer verzögerten Parese des N. femoralis nach Hüfttotalendoprothesenimplantation

Delayed lesions of the femoral or sciatic nerve are a rare complication after total hip arthroplasty. Several cases in association with cement edges, scar tissue, broken cerclages, deep hematoma, or reinforcement rings have been published. We report about a 62-year-old female who developed a pure motor paresis of the quadriceps muscle 2 weeks after total hip arthroplasty. After electrophysiological evaluation had revealed an isolated femoral nerve lesion, revision of the femoral nerve was performed. During operative revision no pathologic findings could be seen. One week later the patient developed paralysis of the left wrist and finger extensors after using crutches. Electrophysiological evaluation revealed several nerve conduction blocks in physiological entrapments and the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP) was established. Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare disease with increased vulnerability of the peripheral nerve system with mostly reversible sensorimotor deficits. It should be taken into consideration in cases of atypical findings of compression syndromes of peripheral nerves or delayed neuropathy, e. g., after total hip arthroplasty.     

M. Perthes

Background

The clinical course of Legg-Calvé-Perthes disease (LCPD) is variable. Diagnosis, nonsurgical and surgical methods of treatment have evolved over many decades, from abduction casts and braces to advanced surgical containment methods which are now the mainstay of treatment.

Methods

This article presents a general view and a critical evaluation of the literature.

Results

The main prognostic factors are patient age at the onset of LCPD, the range of motion and the extent of the necrotic process according to the classification of Herring and Catterall. The main aims of surgical and nonsurgical treatment of LCPD are to prevent prearthrotic deformity of the femoral head, relief of symptoms, containment of the femoral head and restoration of congruence of the hip joint.

Conclusions

Each patient needs to be evaluated individually. Every child must receive an adapted treatment and continued follow-up at regular intervals.     

Distale Ischiadikusblockade in Rückenlage mittels neu entwickelter Ultraschallsondenselbsthalterung

Die Anaesthesiologie - Die sonographisch kontrollierte distale Ischiadikusblockade erfolgt üblicherweise durch Platzierung der Ultraschallsonde auf der dorsalen Oberschenkelseite. Dies...