Der Unfallchirurg
-
Comparative Study
[TFCC-lesion. MR arthrography vs. arthroscopy of the wrist].
In a blinded study from January to July 2000, 125 patients suffering from specific complaints of the wrist were examined with direct MR arthrography prospectively. Within 24 hours an arthroscopy of the wrist was performed. With the MR arthrography in 70 patients or 56% of all patients injury of the TFCC was diagnosed. ⋯ However it could be a potent additional tool for wrist diagnosis if intraarticular contrast is used. It can facilitate the diagnostics and the indication for surgery at the ulnocarpal wrist and help to reduce arthroscopic interventions that are only for diagnostic purposes and without any therapeutic consequences. With improvement of the technique of magnet resonance tomography we can expect further increase of accuracy and the clinical use of the MR arthrography in the diagnostic workup at the ulnocarpal wrist.
-
Clinical evaluation of pediatric head injury is quite difficult and often cranial CT scans are performed. We investigated the relevance of CT scans in relation to the therapeutic outcome. ⋯ Children encountering mild head injury combined with primary loss of consciousness or vomiting, require hospitalisation. Initial CCT did not lead to therapeutic consequences in this group. Children classified as severe head injury or multiple traumatized children need immediate cranial CT scan and hospitalisation.
-
Case Reports Comparative Study
[The direct, dorsal approach to the treatment of unstable tibial posteromedial fracture-dislocations].
The surgical treatment of highly unstable tibial posteromedial fracture-dislocations (medial split fracture,Moore type I) is demanding and may cause significant problems. The anterior and the posteromedial approach require detachment of the medial capsuloligamental structures or arthrotomy of the knee joint. Neither of these operative techniques allow the optimal posterior positioning of the buttress plate in order to prevent caudal dislocation of the fragment during knee flexion. ⋯ Due to the voluminous subcutaneous tissue in the posteromedial tibial aspect, the closure of the skin incision over the medial gastrocnemius muscle can be performed without difficulty. Three cases of tibial posteromedial fracture-dislocation were treated by the direct posterior approach in a prone position in January and February 2002. The present report shows that the direct posterior surgical technique allows optimal exposure, reduction and internal fixation of medial split fractures of the tibial plateau with minimal trauma.