Der Unfallchirurg
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We report an unusual case of incarceration of small bowel between the 4th and 5th lumbar vertebrae in a patient with rheumatoid spondylitis. Incarceration of the loop of jejunum within the fracture or between dislocated lumbar vertebrae is an uncommon entity. The cases of traumatic jejunal entrapment have been previously reported in the literature [1, 2, 3, 4, 5, 6, 7, 8, 9, 11]: 2 cases occurred in adults and 8 in children. There has been no report on this injury in patients with rheumatoid spondylitis (Bechterew arthritis).
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This article reviews the current body of knowledge on the adverse effects of smoking on soft-tissue and bone healing, with emphasis on tibial fractures in combination with severe soft-tissue injury. The pathophysiological effects are multidimensional, including arteriolar vasoconstriction, cellular hypoxia, demineralisation of bone, and delayed revascularisation. Several animal and clinical studies have been published about the negative effects of smoking on bone metabolism and fracture healing. ⋯ Nowadays, there is strong evidence to be very insistent that patients presenting with a (open) tibial fracture should refrain from smoking immediately to promote bone healing and to lower the complication rate. In case of elective reconstructive procedures, patients should refrain from smoking at least 4 weeks before surgery. In both situations, cessation should continue during the full rehabilitation period.
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Comparative Study
[Primary strength of conventional and alternative suture techniques of the rotator cuff. A biomechanical study].
The aim of this biomechanical study was to evaluate rotator cuff repair strength using different suture anchor techniques compared to conventional repair, taking into consideration the native strength of the supraspinatus tendon. Therefore, a defined defect of the supraspinatus was created in 50 freshly frozen cadaver specimen (group size n = 10; median age at death: 56 years). Five methods were employed for cuff repair: standard transosseous suture, modified transosseous suture with patch augmentation and three suture anchors (Acufex Wedge TAG, Acufex Rod TAG und Mitek GII). ⋯ Compared to conventional transosseous suture techniques, the use of the suture anchors tested in this series does not significantly increase the primary fixation strength of rotator cuff repair. The metallic implant with two barbs (Mitek GII) seems to be superior to the polyacetal anchors when inserted into the spongiform bone of the greater tubercle. The considerably weaker repair strength needs to be taken into consideration in postoperative patient rehabilitation, especially after the use of suture anchors.
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The aim of this study was to document the changes in retropatellar pressure, contact area and forces due to different sizes and placement of the patella resurfacing in knee arthroplasty. Six cadaver specimens (after Thiel fixation) were examined after the implantation of the total knee arthroplasty Genesis I. The patella sizes "small" and "medium" were placed as the "onlay" version, centered as well as off-centered by 0.4 cm in all four directions. ⋯ For the medium size, maximum pressure (P = 0.03) increased significantly and force decreased significantly (P = 0.0277) whereas contact area and average pressure increased slightly. The results of the different placements of the patella implant do not support the recommendation for a medial shift. However, at least the lateralized implantation led to a reduction of contact area and force as well as to a slight increase of pressure which is considered as unfavorable.