Der Unfallchirurg
-
Case Reports
[Missed clavicle fracture, deep vein thrombosis following bicycle accident with head and chest trauma].
A 57-year-old patient suffered head and chest trauma following a bicycle accident. After 12 days in hospital with early mobilization the patient developed a deep vein thrombosis 5 days after being discharged and the family physician diagnosed a non-displaced clavicle fracture. ⋯ The expert opinion from the arbitration board determined that no health limitations had occurred as a result of the missed clavicle fracture. There were no indications for anticoagulation in accordance with the guidelines due to a lack of risk factors and the event was deemed unpreventable.
-
Replacement of the anterior cruciate ligament (ACL) is presently routinely carried out with autologous transplantation of the ligamentum patellae (LP), semintendinosus-gracilis (SGS) or quadriceps (QS) tendons. The anatomical positioning of the drilling canals, transplant fixation, complication rate, revision aspects as well as economic aspects are still under discussion. Fixation of the transplant can be carried out mechanically with various anchoring systems or using biological implant-free healing (free of cost). ⋯ This also applies to the double bundle technique. Implant-free replacement of ACLs with the patellar tendon is a suitable, uncomplicated operation technique with comparably low costs and belongs to the state of the art according to Hertel, Petersen and other authors. This method already has a valuable place in surgery of the ACL.
-
Hamstring and patella tendons are usually used for anterior cruciate ligament (ACL) reconstruction and fixed with foreign material, partially executed far from the original point of insertion. Besides the biomechanical questions bone defects are a severe problem in cases of revision. We developed a biological method with diamond cutting instruments for graft fixation with bone dowels near the native insertion. The graft is tensioned and fixed in 120 degrees knee flexion and is self-adapting in extension. The technique has been used in a large number of cases during a prospective study with a follow-up of 10 years for patella tendon and 4 years for hamstring tendon grafts. In this investigation 124 patients with bone-patellar tendon-bone (BPTB) grafts showed an International Knee Documentation Committee (IKDC) score A/B in 87% after a mean follow-up of 9.6 years, a Lachman test (maximum side-to-side difference) of 1.38+/-0.93 mm and a negative pivot shift test in 91% of the cases. Of the 147 patients with hamstring tendon grafts 89% had an IKDC score A/B after a mean follow-up of 4.3 years, a Lachman test of 1.14+/-0.76 mm and no pivot shift in 90% of the cases. The Tegner activity score decreased by -1.8 in both groups. ⋯ This method allows a reliable biological press-fit fixation for every kind of graft near the original point of insertion, preventing bone defects, allowing early intensive rehabilitation and low costs.
-
Case Reports
[Injury to the subclavian and vertebral arteries in childhood following blunt force trauma].
Injuries of great vessels, such as the subclavian or vertebral arteries in childhood are rare. More frequent and therefore better described are dissections of the vertebral artery, which frequently occur following low energy trauma. ⋯ Therapeutic anticoagulation is the therapy of choice to avoid possible ischemic insults. The therapeutic approach of injuries to the subclavian artery remains unclear and is in the focus of discussions.
-
Reconstruction of the anterior cruciate ligament (ACL) is a widely used procedure, but up to now no results have been published on an implant-free technique using a quadriceps tendon autograft and press-fit fixation. ⋯ Reconstruction of the ACL with an autologous quadriceps tendon and an implant-free technique yielded good results compared to established operative methods in the short-term and should be consistently followed-up for long-term confirmation.