Der Unfallchirurg
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The purpose of the present study was to evaluate the effectiveness of a special sensorimotor exercise rehabilitation program on shoulder function. In a prospective intervention study we evaluated 32 patients with subacromial pain syndrome, all of whom took part in a conservative rehabilitation program. No patient had surgery on the shoulder involved prior to the study. ⋯ The sensorimotor test also showed an increased proprioceptive capability especially in the threshold to motion test. The angle reproduction test showed only moderate improvement, whereas the isokinetic strength test showed no improvement at all. The present study shows that patients with subacromial pathology suffer from a proprioceptive deficit which can be improved by a special rehabilitation program within only 4 weeks.
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Radial nerve palsy is a rather frequent complication caused by an accident as well as by surgery of the humerus. As a primary, i.e., accidental lesion, its incidence as stated in the literature is up to 30%, primarily fractures in the distal diaphyseal half. Secondary, i.e., surgically induced, nerve lesions surprisingly are reported with a similar frequency, though recently the incidence only approaches some 3%. ⋯ The stand we take in this controversy is instant revision surgery both for accidental lesions as well as uncompromisingly for those incurred during surgery when the surgeon had not explored the nerve far enough to preserve it during the operation. Three exemplary cases are reported, one of them submitted for an expert's opinion because of an alleged mistake on the part of the doctor. Forensic responsibility has to match actual indication principles and the specific technique applied.
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Case Reports
[In situ connection of a hollow intramedullary nail to the stem of a knee prosthesis in periprosthetic fracture].
Periprosthetic fractures often reveal problems and complications because of poor bone quality. A case report is presented, in which a hollow intramedullary nail was connected, in situ, with the stem of a knee prosthesis (Blauth knee). ⋯ As ultima ratio, a hollow intramedullary nail was placed antegrade on the stem of the knee prosthesis. Afterwards excellent callus formation developed and resulted in consolidation.
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The operative treatment of hand and upper extremity trauma with injury of main vessels becomes a daily standard work in trauma and microsurgical replantation centers. The techniques of vessel and soft tissue reconstruction are well known. The outcome of the replantation depends on various factors. ⋯ It can be influenced by many drugs which are applied according to a replantation schema. Aim of this therapy is the correction of the rheologic properties of a patient. In a patient group of 25 treated with Prostaglandin E1 (Prostavasin) we observed better wound healing with a 80% rate of successful replantation and microvascular vessel reconstruction.
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During the last years minimal-invasive augmentation techniques of vertebral bodies have been established to stabilize painful height losses. A vertebroplasty fills the vertebral body with cement, whereas a kyphoplasty intends to achieve a reduction of kyphosis prior to cementing. The present review describes both techniques and summarizes in vivo and in vitro experiences.