Der Unfallchirurg
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Randomized Controlled Trial Comparative Study Clinical Trial
[Clinico-histologic comparison of allogenic and autologous bone-tendon-bone using one-third of the patellar tendon in reconstruction of the anterior cruciate ligament].
Reconstruction of the ruptured anterior cruciate ligament (ACL) using modern techniques achieves successful long-term results in up to 90% of all cases. Yet the discussion continues as to the suitable implant to replace the ACL in terms of donor morbidity, implant reaction, long-term results, and potenzial risk of carrier concerning the allograft. The clinical and histological results from 2 years experience with the BPTB allograft (Tutoplast) and the BPTB autograft for ACL reconstruction are compared with reference to stability, functionality, rerupture rate, and histological reaction of the remodelling process. ⋯ There were clearer and more protracted indications of hypercellularity and hypervascularity, and the collagen matrix had not regularly aligned longitudinally even 1 year later. A detailed analysis of the BPTB allograft group indicated that especially in young and very sporty patients there is increased elongation of the implant and a clearly higher rerupture rate. Hence, according to the data we have collected, it would seem that the use of the BPTB allograft (Tutoplast) is not suitable especially in young patients who frequently practice high-level sports involving high knee stress.
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Pelvic disruptions are rare in children caused by the flexible anchoring of bony parts associated with a high elasticity of the skeleton. Portion of pelvic fractures in infants is lower than 5% even when reviewing cases of specialized centers. The part of complex pelvic injuries and multiple injured patients in infants is higher when compared to adults, a fact caused by the more intense forces that are necessary to lead to pelvic disruption in children. ⋯ The acute hemorrhagic shock is one of the leading causes of death following severe pelvic injuries. After stabilization of fracture, surgical treatment of soft tissue injuries and intraabdominal bleeding sources the immediate diagnostic angiography possibly in combination with a therapeutic selective embolization is a well established part of the treatment. The aim of complete restitution can only be accomplished by cooperation of several different specialists and consultants in a trauma center.
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Some 30% of unstable vertebral fractures of the thoracic and lumbar spine involve a destruction of the ventral column and thus of the supporting structures of the spine. This requires extensive surgical reconstruction procedures, which are carried out using minimally invasive techniques. The disadvantages of the minimally invasive methods are the high cost, the technical equipment and the expenditure of time required in the initial phase for the performance of the surgical procedure. ⋯ Considering the case values to date, a contribution margin deficit of EUR 4628.45 has been calculated for our patients with fractures of the thoracic and lumbar spine without neurological defunctionalization symptoms. An economically efficient medical care is thus no longer possible. Consequently, an adjustment of the German relative weights must urgently be demanded in order to guarantee a high-quality medical care of patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Reduction of severe cardiac complications during implantation of cemented total hip endoprostheses in femoral neck fractures].
Intraoperative circulatory and pulmonary problems occuring during the repair of femoral neck fractures with cemented hip arthroplasty are a common problem, that cannot be ultimately explained. As a possible reason for this problem is air embolism during the polymerisation of the methylmethacrylat discussed. We started a prospective randomised clinical examination with 72 patients to prove the efficiency of palacos mixed in vacuum, with respect to the reduction of severe cardiovascular complication during endoprosthetic repair of femoral neck fractures. ⋯ Mortality in the control group amounted to 13.8% in the vacuum group to 2.8%. Through the use of methylmethacrylate mixed in vacuum for surgical repair of femoral neck fractures with cemented hip arthroplasty, the incidence of severe cardiac complications could be reduced significantly. Patients with increased pulmonal arterial pressure have the highest risk for cardiac complications.