Der Unfallchirurg
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To analyze a prototype mobile C-arm image amplifier (Iso-C3D) in the evaluation of different joint fractures of the upper and lower limbs using multiplanar reconstruction (MPR). Different cadaver joint specimens (n = 14) were examined with a prototype (Iso-C3D, Siemens AG, Erlangen, Germany), plain radiographs (CR), and spiral computed tomography (CT). The motorized C-arm provides fluoroscopic images during a 190 degrees orbital rotation computing a 119-mm data cube. ⋯ Initial data show that fractures were easily depicted and correctly classified on MPR images with the Iso-C3D and that there was no difference between the Iso-C and CT in the detection of fractures. The preliminary results suggest a remarkably good detection of joint fractures with the Iso-C3D. Studies in an adequate number of patients are required to elucidate whether these promising results can also be obtained in a clinical setting.
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The objective was to evaluate long term results after removal of a popliteal cyst with special focus on recurrence rate and associated intraarticular pathology. Between 1982 and 1995 71 patients (23 women and 48 men between 21 and 75 years of age) underwent removal of a popliteal cyst. An additional arthroscopy of the knee joint was carried out in 51 consecutive patients starting in 1988. ⋯ It depends strongly on the type of associated intraarticular pathology. Especially grade III and grade IV chondral lesions correlated significantly with recurrence of a popliteal cyst after removal. Therefore, the main goal of surgery should be the successful treatment of associated intraarticular pathologies.
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Spinal epidural hematoma are a rare but serious complication of thoracic stab wounds. Their incidence should always be taken into consideration when first examining the patient, and it is also necessary to be able to find proof in either MRI or CT-scan. In our case the patients diffuse neurologic symptoms connected with a rather unreliable appearing personality made the diagnosis even more difficult. Initially it was possible to show the defect only in MRI.
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Between March 1997 and October 1999 thirty-one patients with displaced proximal humeral fractures were treated with crossed screw osteosynthesis. Insertion of the screws was realized by using a deltoideo-pectoral approach placing the screws anteriorly and posteriorly in a crossed manner from the distal fragment into the humeral head. Additionally, in all two-part-fractures a tension band was applied. ⋯ However, in 3 patients results were only "poor" (1 two-part-, 2 three-part-fractures). The complication rate was 29% (premature hardware removal due to head perforation in 3 cases; humeral head necrosis necessitating prosthetic replacement in 2 patients; secondary displacement in 1 case). Crossed screw osteosynthesis represents an justified alternative in the surgical treatment of displaced proximal humeral fractures permitting early functional therapy.