Der Unfallchirurg
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Basis of the modern shoulder implants is the Neer II-system, a non constrained total shoulder prosthesis with conforming radii of curvature and improved protection against dislocation. The second generation of shoulder prosthesis is based on the geometric shaft design of the Neer II prosthesis and offers not only a variety of modular head- and shaft-sizes but also through different radii a physiologic rotation-translation-mechanism. The third generation of humeral head prosthesis carries the concept of an anatomic reconstruction one step further and enables the surgeon to adjust the inclination and the eccentric offset of the humeral head to restore the centre of rotation. ⋯ Walch categorised the different glenoid lesions and developed a very important classification of possible glenoid deformations. To compare and evaluate the operative results one must consider the different shoulder prosthesis and the discrepancies between a hemi- and a total shoulder prosthetic replacement. Looking at the loosening and survival rate of the implant the results are
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From January 1st 1990 to December 31st 1997, 614 children were treated for supracondylar humerus fracture at the Department of Orthopedic Surgery in the Olga Hospital, Stuttgart. Ten of these children had concomitant vascular complications. The concept of treatment we had chosen was analysed retrospectively. ⋯ Late ischemic damage (cold intolerance, claudicatio, Volkmann's contracture) were not detected in any of the children. Appraisal of elbow joint mobility revealed a median extension deficit of 0 degrees (range 0-10 degrees ), a median flexion deficit of 0 degrees (range 0-15 degrees ) and a normal pronation and supination equal on each side. The load-carrying joint axis was normal in a comparison of the sides in all children.
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Each acetabular fracture means a huge intellectual and a demanding technical challenge for the surgeon on charge. Because the hip joint is situated within a complex three-dimensional structure the diagnostics of its lesions are difficult. Three conventional X-ray views enable the recognition of a specific fracture type, computertomographic cuts give a detailed view on the type and the severity of the cartilage lesions, threedimensional reconstructions make a clear spatial imaging of the fracture configuration possible. ⋯ When operated on quickly, open reduction and internal fixation can also give gratifying results. Alternative methods as primary or secondary total hip arthroplasty are at least as demanding for the patient and are combined with a high percentage of loosening of the acetabular component. The rarity and complexity of acetabular fractures asks for a specific teaching and learning with a experienced acetabular surgeon.
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There are 2 types of a combined tibia fracture and ankle injury: in Type I the tibia fracture extends directly into the ankle joint, in Type II the tibia fracture goes along with a fracture of the fibula and disruption of the fibular-tibial syndesmosis. This type of fracture must be distinguished from a pilon tibiale fracture. The typical mechanism for this combined tibia and ankle injury is the indirect torsional trauma with pronation-eversion. ⋯ The attention should be focused to the ankle joint in any spiral fractures of the distal tibia after indirect trauma, especially with a proximal fibular fracture or an intact fibula. Additional X-ray examination of the ankle joint is recommended during internal fixation of the tibia. Posttraumatic arthrosis of the ankle joint can be prevented by diagnosis and adequate anatomical reconstruction of the additional ankle joint injury.