Der Unfallchirurg
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Paralysis of elbow flexion or extension leads to major impairment of upper extremity function. Surgical reconstruction can be achieved using several procedures. If the time interval since the nerve injury is short, anatomic reconstruction by means of nerve suture or nerve transplantation should be attempted. ⋯ Latissimus dorsi transfer to reconstruct elbow flexion is also indicated in defects of the anterior upper arm muscle compartiment due to trauma, ischemia, or tumor. Patients with proximal radial nerve lesions may benefit from latissimus transfer to reachieve elbow flexion extension. In tetraplegic patients, elbow extension is restored mainly by transfer of the posterior deltoid muscle extended with a tendon graft, or by means of a biceps-to-triceps transfer.
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Arthrofibrosis is a disabling complication after knee trauma and surgery and is characterised clinically by joint stiffness. Due to an immune response, the proliferation of fibroblasts and synthesis of extracellular matrix proteins are increased. The cytokines transforming growth factor beta (TGF-beta) and platelet-derived growth factor (PDGF) are critical players in tissue fibrosis, stimulating cell proliferation and the production of various extracellular matrix proteins. ⋯ Both cytokines could be detected subsynovially around inflammatory cells. The profibrotic cytokines TGF-beta and PDGF play an important role in the pathogenesis of arthrofibrosis. Both cytokines are key mediators of tissue fibrosis.
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Sinus tarsi syndrome, described by O'Connor in 1958 and Brown in 1960, is a clinical finding often seen after an accident, consisting of a painful reaction to pressure on the sinus tarsi. This syndrome has also been described in dancers, volleyball and basketball players, overweight individuals, and patients with foot deformities (flatfoot). We looked for mechanical and functional macroscopic structures in the canalis and sinus tarsi that can be associated with sinus tarsi syndrome in order to deduce therapeutic consequences. ⋯ While contracting the long extensor muscles of the toes, the ligament forms a control mechanism for the longitudinal arch of the foot in the moving phase. A question is how variations in vascularization or disorders in innervation will alter the turgor of the pads of fat tissue. That is, such alterations would influence the distribution of synovia in the neighboring joints as well as the tension of the involved ligaments.
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According to the literature, differences in torsion of 15 degrees and more develop in 20-30% of cases after intramedullary nailing of femoral shaft fractures. A computer-assisted method makes it possible to determine the antetorsion angle during surgery. In this experimental study, the precision of the measurements obtained with the navigation system were checked with a femur model and compared with a CT reference method. ⋯ When comparing the absolute values of the navigation and reference systems, the mean deviations of both methods are around 1 degrees (0.35; 1.75) and comparing the differences 0.5 degrees (-0.2; 1.17). The maximum deviation of the absolute values of the CT reference method amounts to 6.4 degrees. Under experimental conditions, measurement of the femoral antetorsion angle proved to be sufficiently precise for clinical specifications in comparison to a CT reference method.
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Comparative Study
[Proximal femur fractures: results and complications after osteosynthesis with PFN and TGN].
The primary aim of surgery for pertrochanteric fractures of the femur is to regain preoperative mobility as quickly as possible. The aim of this study was to investigate whether clinical or radiological differences could be found between proximal femoral nails (PFN) and trochanteric gamma nails (TGN), with particular attention given to technical differences in implantation and early complications. ⋯ PFN are better suited to 31A1 fractures because of their higher rotational stability from the use of dual screws. A short femur and high antecurvation can cause insertion problems in PFN because of the nail design. It is advisable to choose the type of implant during preoperative planning after considering fracture type and patient anatomy.