Der Orthopäde
-
The borderline indications of locked intramedullary nailing of the femur and the tibia, based on Küntscher nailing, are defined by the location of the fracture, the associated soft tissue injury, the appearance of infection and the patient's pulmonary status. From 1975 to 1995 at the Department of Traumatology, Vienna University School of Medicine, 551 patients with 559 femoral fractures and 536 patients with 548 tibial fractures were stabilized using locked intramedullary nailing. A total of 135 (24%) proximal femoral fractures were stabilized using intramedullary locking nails in 54 cases, and using long gamma nails in 81 cases. ⋯ Six tibial fractures diagnosed as having compartment syndrome were treated using unreamed nailing and fasciotomy. The overall infection rate of femoral fractures was 1.7% and 1.9% for all tibial fractures; the nonunion rate of both femoral and tibial fractures was 0.5%. Because of the success rate observed in the treatment of borderline indications for locked intramedullary nailing of femoral and tibial fractures and the improvement in equipment, training and techniques, we have expanded the indications for treatment of these fractures by intramedullary nailing.
-
Today intramedullary nailing is the treatment of choice in stabilizing femoral and tibial diaphysial fractures because of its superior bone healing compared to other forms of osteosyntheses. By interlocking, the indication can be extended to all fractures in which interlocking bolts can be fixed in the proximal and distal main fragment. Küntscher's principle of elastic clamp has changed to intramedullary splinting. ⋯ Therefore unreamed nailing is the treatment of choice, if the situation of the patient allows the procedure of nailing in itself. Multitrauma patients in shock or with unstable circulation should be stabilized primarily with external fixation. After consolidation, early change to an intramedullary nail should be performed.
-
The goal of treatment of open fractures is to prevent infection, promote fracture healing, and restore normal limb alignment and function. The initial treatment of these fractures includes: debridement, soft tissue coverage, antibiotic therapy, and fracture stabilization. ⋯ In contrast to the biological problems in the tibia, those problems encountered in the femur are more predominantly mechanical in origin. For humeral shaft fractures, shoulder problems associated with the antegrade approach are frequent, and bypassing the rotator cuff with a retrograde approach appears advantageous.
-
Soft-tissue defects in the extremities vary greatly, depending on the trauma mechanism, localization and a number of factors related to the patient's physical condition. We offer an overview of the plastic surgery methods in reconstruction of different soft-tissue defects in the extremities, beginning with the diagnostic, clinical and radiological measures that make classification of soft-tissue defects possible, and then giving a concentrated view of the appropriate reconstruction methods. Collaboration between traumatology and plastic surgery seems to be especially important in lesions in the extremities.
-
The percentage of elderly people in our population is increasing, and anaesthesiologists and surgeons need to find ways of decreasing perioperative complications in these patients. The chronological age is of lesser importance than biological age as far as the risks of perioperative complications are concerned. Indicators for biological age are the number and type of previous diseases, nutritional status and the doctor's clinical impression of the patient. ⋯ The most frequent perioperative complications are alterations to the cardiopulmonary system and postoperative bleeding. Even minor perioperative complications can have a predictive value for later fatal events. Thus, careful preoperative preparation, a suitable anaesthetic procedure and a fast and atraumatic mode of operation will help to decrease perioperative complications in elderly patients.