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Dr. S. Studier-Fischer A. Moghaddam C. Wagner G. Zimmermann A. Wentzensen 《Trauma und Berufskrankheit》2005,7(2):97-102
Zusammenfassung Die Humerusschaftfraktur ist in 10–18% der Fälle durch primäre Radialisparese kompliziert. Sekundäre Radialisläsionen treten iatrogen bei intramedullären Verfahren in 3%, bei Plattenosteosynthesen in 15,5% auf. In der überwiegenden Mehrzahl der Fälle (80%) ist der Radialisschaden rückläufig. Eine Verletzung der A. radialis ist eher selten; sie erfordert ein offenes Vorgehen mit lokaler Revision des Gefäßes und Frakturversorgung mittels Plattenosteosynthese. Die Marknagelosteosynthese ist bei einfachen, komplexen oder pathologischen Schaftfrakturen primär oder als Verfahrenswechsel nach primärer Fixateuranlage indiziert. Während auch ausgewählte Frakturen im Collum chirurgicum mit einem Nagel versorgt werden können, sind Frakturen im distalen Viertel des Humerus ausgeschlossen. Frakturen bei kleinen Kopffragmenten weisen ein erhöhtes Komplikationsrisiko auf. Zur Vermeidung von Läsionen der Rotatorenmanschette stehen wir der anterograden Nagelung noch zurückhaltend gegenüber. Bei differenzierter Indikationsstellung und Nachbehandlung erwies sich die retrograde Marknagelung als ein schonendes Verfahren mit hohem Patientenkomfort und gutem funktionellem Ergebnis. 相似文献
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Trauma und Berufskrankheit - Zusammenfassung In 115 Fällen von Oberarmschaftfrakturen wurden 12 primäre (10,4%) und 2 sekundäre (1,7%) begleitende Funktionsstörungen des N.... 相似文献
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Intramedullary nailing of tibial fractures is a widely accepted method of osteosynthesis. Up to now intramedullary nails could not be employed for fractures and osteotomies in the most cranial fifth of the tibia, because no retrograde implantation technique was available.This situation is very different to femur and humerus,where retrograde implantation of intramedullary nails is clinical routine in osteosynthesis since a few years.Following anatomical and biomechanical studies we developed an operation and implantation technique for retrograde tibial nailing. This is the report of some clinical studies on the topic.The first results support retrograde tibial nailing as an advantageous and less invasive alternative to plate-osteosynthesis in some cases of very proximal tibial fractures and very high osteotomies. 相似文献
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The treatment of diaphyseal fractures of the humerus is discussed in the literature as a controversial subject. For many decades, conservative treatment was regarded as the only option for these fractures, but in the last 10 years there has been a remarkable shift towards internal stabilization and fixation with plates or unreamed nails. Use of an external fixator is very seldom indicated for diaphyseal fractures of the humerus. It should be used exclusively for temporary primary fixation in polytraumatized patients and in cases with severe soft tissue damage. An internal osteosynthesis should follow as soon as possible, because of the high rate of complications – pin-track infections in up to 50%, deviation of axis in 64%, nonunion in up to 57% – with external fixation of humeral fractures. 相似文献
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Zusammenfassung Durch die Entwicklung der Marknagelung in den letzten 30 Jahren hat sich die Behandlung von Femurschaftfrakturen geändert. Die antegrade Marknagelung ist operatives Standardverfahren, kann bei entsprechenden Begleitverletzungen aber nicht immer eingesetzt werden. Für solche Situationen bietet sich die retrograde Marknagelung an. Unter Berücksichtigung der Frakturkonsolidierung können mit beiden Verfahren hervorragende Ergebnisse mit Raten über 90% erzielt werden. Das Aufbohren des Markraums führt sowohl bei ante- als auch retrograder Marknagelung zu keiner erhöhten Komplikationsrate. Nachteile der antegraden Marknagelung sind mögliche heterotope Ossifikationen sowie Nervenschädigungen. Dagegen wurde auf vermehrte Knieschmerzen nach retrograder Nagelung verwiesen. Eine Einschränkung der Kniebeugung <40° kann das Einbringen des retrograden Nagels unmöglich machen. Die retrograde Marknagelung ist bei floating knee, offener Knieverletzung, ausgeprägter Adipositas, Polytrauma, Kombination einer Femurschaftfraktur mit einer ipsilateralen Azetabulum-, Schenkelhals- oder Patellafraktur, zusätzlicher intra-/suprakondylärer Femurfraktur sowie Femurschaftfrakturen bei liegender Knieprothese indiziert. 相似文献
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Dr. D. M. Menger J. -U. Gauger A. Schmitt-Köppler 《European journal of trauma and emergency surgery》1985,11(2):70-75
From January 1, 1981 until August 31, 1983, 27 fractures of the corpus humeri were treated with bunch nailing, according to Hackethal. 23 Patients had one or more further injuries and/or accompanying diseases, which did not allow conservative therapy. Only 4 patients had nothing but a corpus humeri fracture, and only for professional reasons they asked for surgery. The operation method was secure and without complications. After a few days, exercise therapy was possible; and in the average full load capacity was reached after 6 weeks. 3–18 months after surgery 85% of the patients with aftercare (n=18) said that the treatment brought “good” or even “very good” results; in all cases the functional and anatomic results were good. 相似文献
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B. Gay J. Riemenschneider B. Gutzeit 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》1983,361(1):769-769
Zusammenfassung Eine Analyse der Ursachen von 142 Oberarmschaftspseudarthrosen und die Überprüfung der Resultate von 124 konservativ sowie 88 operativ behandelten Oberarmschaftfrakturen zeigen, daß die konservative Therapie bei bestimmten Frakturformen problematisch ist. Es wird daher eine Erweiterung der Indikationsstellung zur operativen Therapie im Sinne der Plattenosteosynthese nach den Richtlinien der AO empfohlen. 相似文献
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H. Spängler 《Archives of orthopaedic and trauma surgery》1961,52(5):575-579
Zusammenfassung Der seltene Zwischenfall eines Bruches des Führungsspießes bei offener Marknagelung und Austritt des Fragmentes in den Markraum neben den Nagel wird beschrieben und als Ursache eine Inkongruenz zwischen Nagel und Führungsspieß angenommen. Extraktion des Fragmentes bei Entnagelung durch kleine Fensterung des Markraumes. Empfehlung genauer Überprüfung des Zusammenpassens von Führungsspieß und Marknagel bzw. Führungsrinne vor der Operation. Röntgenbilder zur Demonstration.Mit 4 Textabbildungen (11 Einzelbilder) 相似文献
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M. Krause 《Archives of orthopaedic and trauma surgery》1967,61(2):123-127
Zusammenfassung Es wird berichtet über die Möglichkeit, Oberarmschaftbrüche einschließlich der subkapitalen Frakturen mit geraden und starren Küntscher-Nägeln zu versorgen. Die Einschlagstelle ergibt sich aus der Arthrodesenstellung der Schulter, sie liegt im Winkel zwischen Acromion und Clavicula, also dorsal von der Clavicula. Es eignen sich besonders die Oberarmbrüche bei Schultergelenkarthrodesen dafür. Auch Frakturen bei älteren Patienten können in dieser Weise versorgt werden, wobei der Nagel tief eingeschlagen werden sollte unter Verzicht auf eine spätere Entfernung.
Summary The author reports on the possibility of supplying fractures of the humerus shape, including the fractures below the head of the humerus (subcapital fractures) with rectilinear and stiff Küntscher nails. The spot, where the nail should be driven in, results from the position of the arthrodesis of the shoulder, the spot is situated in the angle between acromion and clavicule, thus back of the collar-bone. Especially the fractures of the humerus in cases of arthrodeses of the shoulder-joint (humeral articulation) are qualified for this procedure.
Résumé L'auteur fait rapport détaillé de la possibilité de traiter les fractures — de la tige de l'humérus, y compris les fractures sous-capitales, avec des clous de Küntscher droits et raides. L'endroit de l'enfoncement s'ensuit de la position de l'arthrodèse de l'épaule, elle est située à l'angle entre l'acromion et la clavicule, donc en arrière de la clavicule. Ce sont en particulier les fractures de l'humérus chez les arthrodèses de l'articulation humérale qui sont aptes à un tel clouage.相似文献
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Objective
Intramedullary stabilization of periprosthetic distal femoral fractures by interlocking nailing. Closed reduction by retrograde nail can be combined with the use of transmedullary support screws (TMS principle of Stedtfeld).Indications
Supracondylar fractures above stable knee arthroplasty (Rorabeck types I and II), femoral shaft fractures ipsilateral of stable hip and/or knee arthroplasty, contraindications for antegrade nailingContraindications
Closed box design of femoral implant, intercondylar distance of the femoral component smaller than nail diameter, more than 40° flexion deficit of the knee, inability to place two bicortical distal interlocking screws. Relative contraindication: insufficient overlap with proximal implantsSurgical technique
Supine position and knee flexion of approximately 45°. Fluoroscopy should be possible between the knee and hip. Longitudinal skin incision into the pre-existing scar over the patellar tendon which is then split. The nail entry point is located in the intercondylar groove at the deepest point of Blumensaat’s line, often predetermined by the femoral arthroplasty component. Reaming is rarely necessary. Transmedullary support screws may correct axial malalignment during nail insertion. Static interlocking in a direction from lateral to medial by the aiming device. Insertion of locking cap.Postoperative management
Retrograde nailing normally allows full weight bearing. Range of motion does not need to be restricted.Results
Out of 101 fractures treated between 2000 and 2013 with a Targon RF nail (Aesculap, Tuttlingen, Germany) 10 were periprosthetic, all were classified as Rorabeck type II and of these 6 fractures were metaphyseal and 4 were diaphyseal. In four cases proximal implants were present. The mean operative time for periprosthetic fracture fixation did not significantly differ from that for normal retrograde femoral nailing. There were no postoperative infections, fixation failures or delayed unions. There was one revision for secondary correction of maltorsion. 相似文献12.
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Following the insertion of an intramedullary nail, the fat embolism is a frequent complication in patients with long bone fractures. The respiratory function of patients with fractures of the femur and accompaning severe chest injuries was improved. In general these patients have a high risk to develop a respiratory distress syndrome. The average age of the 22 polytrauma patients studied was 40 years. The injury's severity as assessed using the Hannover Polytrauma-Score (PTS) and the average score was 29 points. Using Suter's scoring system the severity of the respiratory distress syndrome was assessed (Table 3). The insertion of an intramedullary nail was performed on 18 patients. Four of them developed an ARDS (adult respiratory distress syndrome) up to grade IV for a period of 5 days. Two patients suffered an ARDS grade I for a period of 2 days. In the study no typical features of fat embolism syndrom were found in any of these patients. 相似文献
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Fragestellung. Bedingt durch Osteoporose und der fehlenden Propriozeption k?nnen bereits marginale Traumen bei Querschnittgel?hmten zu komplexen Extremit?tenfrakturen führen. Die Besonderheiten der Wund- und Frakturheilung plegischer Patienten erfordern eine übungsstabile Osteosynthese mit geringer Weichteilsch?digung zur frühzeitigen Physiotherapie. 相似文献
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Most cases of unstable humeral fractures in children can be treated by elastic stable intramedullary nailing (ESIN); however, it is essential to realize the limitations of this procedure. Good indications are transverse or short oblique fractures. In the case of multifragment or open fractures it could be necessary to use external fixation. Plate osteosynthesis is indicated in exceptional circumstances. In cases of nerve irritation the findings have to be recorded in the patients file and in certain cases should be treated or referred to institutions with the necessary experience. 相似文献
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Doz. Dr. O. Kwasny R. Maier F. Kutscha-Lissberg W. Scharf 《European journal of trauma and emergency surgery》1992,18(3):168-173
We give an account of 28 patients with fractured humerus diaphysis, suffering from primary and seven patients suffering from secondary lesion of the radialis nerve, all treated by operation. In each case the radialis nerve was exposed and the fracture was treated by fixation with compression plates. In case of primary lesions of the radialis nerve, we found intraoperative damages by traction (six times), contusions (seven times), intraneural hämatomas (six times) and for one time perforation of the nerve by bones. The rest of this group (eight times) did not show any pathological finding. Those patients with secondary lesion of the radialis nerve showed damages by traction (three times) and in two cases the nerve was walled up by callus or connective tissue. Two times we could not find any pathological alteration of the nerve. 23 (six) out of 28 (seven) patients with primary (secondary) lesion of the radialis nerve could be followed up. On this occasion we stated complete neurological restitution 20 times (four times) and incomplete restitution three times (two times). The great number of pathological findings, which necessitate operative treatment, the short duration of remission and the high rate of restitution confirm us to leave the way of conservative treatment in cases of primary or secondary lesion of the radialis nerve and the indication of acute operation is given. 相似文献
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Current results of intermedullary fixation in the forearm are briefly presented and discussed. The surgical technique is challenging, but with appropriate experience the results achieved are certainly comparable to those obtained with plating. Refracturing following removal of the implants has so far not been observed after this technique, in contrast to plating. The advantages of intramedullary osteosynthesis are the much lower invasiveness and the fracture consolidation typically seen with osteosynthesis involving nailing. 相似文献
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A. Slany 《Archives of orthopaedic and trauma surgery》1944,43(1):131-147
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Reaming and non-reaming of intramedullary nails in long bone fractures was a controversial and even emotional topic in recent decades. This article gives an historical overview of the development in this field and presents the background to the need for unreamed nailing. Furthermore, the current state of knowledge is illustrated by describing the results of a series of randomised controlled trials. Before the year 2000 nearly all German handbooks on orthopaedic and trauma surgery recommended unreamed intramedullary nailing as a more “biological” treatment that causes less harm to vascularity with equal or even better results. Unreamed nailing was in particular advocated for the treatment of open fractures. The tide turned as randomised controlled trials conducted since 2000 gave evidence that unreamed nailing leads to a higher rate of delayed or non-union, while the advantages to blood supply and infection rate could not be proven. According to evidence based medicine isolated femur and tibia fractures should be nailed in a reamed procedure. In a severe multiple injury setting it is safer to stabilize long bone fractures with external fixators, as adverse events are described for reamed and unreamed nailing. 相似文献
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The investigation of 286 humerus shaft fractures shows very interesting interrelations between fracture localisation and form, kind of trauma, age and sex. Form and localisation of fractures reveal certain differences in time of fracture union. The therapy results justify the conservative treatment. Primary osteosynthesis should be done only exceptionally with strict indication. 相似文献