Der Unfallchirurg
-
Due to the advances in prosthesis design and standardisation of implant techniques, the maintenance of implants in arthroplasty of the knee joint has enormously increased during the past few years. Various arthroplastic designs enable an adjustment towards the patient's individual indiction and anatomy. ⋯ Prerequisite for mere joint resurfacing is an intact lateral ligament apparatus, whereas the the symmetrical ligament balancing is essential for long-term analgesia, joint stability and good flexion. Aseptic loosening, discreet infections, instabilities and patellar problems are common reasons for painful knee arthroplastics.
-
Case Reports
[Late reconstruction of distal biceps tendon rupture with fascia lata graft and Mitek anchors].
Ruptures of the distal biceps tendon are rare but well documented. A technique for reinserting the distal biceps tendon into the radial tuberosity with two Mitek anchors and a fascia lata graft is presented and illustrated by a case report. Ectopic ossification as a complication after the procedure is discussed as well as the final outcome. It could be concluded that late reconstruction of the distal biceps tendon rupture with fascia lata and Mitek anchors is a safe procedure that can be advocated in a restricted number of cases where acute injury has been overlooked.
-
Analgesia is one of the physician's genuine challenges. Pain makes the patient suffering and leads to unfavourable somatic effects as well, which may have negative outcome effects. Sufficient perioperative analgesia depends on well defined organizational conditions. ⋯ Special syringe pumps allow a patient controlled analgesia (PCA) under fixed conditions. Regional anaesthesia via catheter is powerful as well and avoids systemic opioid side effects. In these cases as well, a continuous or patient controlled analgesia is possible.
-
Unstable pelvic ring injuries AO type C ("vertical shear") with a fractured sacrum are treated operatively in less than 50% of the cases (DGU pelvis study group). Furthermore, only 12% of these ORIF involve the sacrum bone itself. No specific technique has gained wide acceptance in treating transsacral instability. ⋯ This allowed immediate mobilization in all cases. The radiologic follow-up examination ( n=20) revealed a solid union in all patients. Complications focused on management of the soft tissue degloving injury (Morel-Lavalleé lesion), which needs special attention.