Der Unfallchirurg
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Comparative Study
[Prospective comparison of MRI vs. direct magnification radiography in occult fractures of the scaphoid bone].
The diagnosis of occult fractures of the scaphoid bone is even more challenging than that of conventional fractures of the scaphoid. This study aimed to compare prospectively the gold standard method (plain radiographs in four projections, after about 14 days) and the primary findings with direct magnification radiography (DIMA) and magnetic resonance imaging (MRI). ⋯ This may lead to a decreasing time of disease. DIMA was inferior in detecting occult fractures of the scaphoid.
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Comparative Study
[Comparison of internal fixation methods for the symphysis in multi-directional dynamic gait simulation].
For the stabilization of the ruptured pubic symphysis, rigid forms of fixation such as plate osteosynthesis and flexible fixations such as wire loops or PDS banding have been recommended. All methods have only been tested by static unidirectional loading until failure of the system. By this experimental arrangement Ecke and Hofmann found comparable results for flexible and rigid methods of internal stabilization of the pubic symphysis. ⋯ Overwinding of the screws, as in osteoporotic bone, lead to increasing loosening during repeated loading, whereas primary stable fixation of the screws was almost completely maintained during the test. In consequence, neither wire loops nor PDS banding should be used for stabilization of injured pubic symphysis if early mobilization with partial weight bearing is desired. Plate osteosynthesis (DC or reconstruction plate) tolerates early half weight bearing in patients with "open-book" injury only if safe screw fixation is guaranteed.
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Some 13% of fractures in children are in the foot. Of these fractures, 50% involve the metatarsals and the phalanges. These are treated conservatively and do not cause therapeutic problems in general. ⋯ The precise scientific assessment of foot fractures in children is confronted with the problem that so far too few cases have been evaluated. Rare problematic fractures (i.e. talus, calcaneus) require scientific work-up to establish a "gold standard" for operative and conservative treatment. This can only be accomplished in a multicenter study.