Der Unfallchirurg
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Comparative Study
[Considerations for the indications for anterior cruciate ligament reconstruction. Results of conservative versus operative treatment].
Medium-term results with a follow-up of at least 3 years were done in 160 patients (average follow up 51 months) after ACL reconstruction using IKDC evaluation form and Noyes score and in 110 patients (average follow Up 53 months) after non-operative management. Unlike objective good parameters the subjective assessment of knee function according to the Noyes score reveals significantly worse results in cases with ACL reconstruction compared to the knees without surgery. The best functional results we found in professional athletes after ACL reconstruction. ⋯ Only when menisceal lesions appear or patients suffer from giving way episodes we support secondary surgery. The pivot shift sign is reflecting the dynamic aspect of knee instability. In our opinion it is the decisive parameter to assess knee instability unless there are useful technical procedures.
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Comparative Study
[The value of CT in classification and decision making in acetabulum fractures. A systematic analysis].
The classification of acetabular fractures and especially the diagnosis of additional lesions can be misleading, when the personal experience is limited and the decisions are based only on conventional radiographs. The introduction of Spiral-CT with multiplanar reformations and 3-D views has improved the quality of visualization. Due to their higher costs, the need of these additional diagnostic tools is frequently questioned. This paper discusses the relevance of plain radiographs, 2-D-CTs, 3-D-CTs and Femursubtraction-CTs (FsCT) for the classification of acetabular fractures, based on a controlled study. ⋯ The "correct" fracture classification based on plain radiographs was: group I, 11%; group II, 32%; group III, 61%. Based on 2-D-CT a "correct" diagnosis was reached by 30% in group I, by 55% in group II, and by 76% in group III. With consideration of the "transient forms" in acetabular fractures based on Letournel and the 3-D-CT used mainly by group I, the rate of "correct" classifications rose to 65% in group I, 64% in group II and 83% in group III. The modifiers were diagnosed "correctly" in group I by 37%, in group II by 56%, and in group III by 73%. The use of the 3-D-CT and especially the Fs-CT by group I resulted in an improvement in the rate of correct classifications to 61%, whereas in group II the Fs-Ct was used only exceptionally. The 2-D-CT was the basis for the diagnosis of the additional lesions in acetabular fractures within all groups resulting in 73% complete diagnoses in group III. This study showed the importance of CT for the exact analysis and classification of acetabular fractures. In particular, the secondary reformations in CT and the 3-D-views dramatically improved the rate of "correct" classifications in the group of surgeons with limited personal experience in acetabular surgery. This allows the less experienced an acceptable level of "correct" diagnoses, so that the treatment options can be weighed correctly. Among the "experts" a rate of divergent classifications of approximately 20% was observed, especially in "transient" forms of acetabular fractures.
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Review Comparative Study
[Management of polytrauma patients in an international comparison].
Worlwide there will be an increase in polytraumatized patients. The number of death after trauma will increase from 5.1 Mill. to 8.4 Mill. The reason is the technical progress in the third world. ⋯ The Trauma register in Germany contents till now 2.069 polytraumatized patients. The lethality is 18.6% (ISS 21 +/- 13), comparing to MTOS (ISS 12.8 +/- 11.3, lethality 9.2%). The differences in injury pattern show in the US three times more penetrating injuries than in the German Traumaregister (21.1% versus 7.2%).
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Anterior cruciate ligament (ACL) reconstruction using autologous hamstring tendons are being performed more frequently and satisfactory results have been reported. Advantages such as low donor site morbidity and ease of harvest as well as disadvantages like low initial construct stiffness have been described. Recently, it has been demonstrated that graft fixation close to the original ACL insertion sites increases anterior knee stability and graft isometry. ⋯ In addition, initial pullout force can be greatly improved by harvesting the hamstring tendon graft with its distally attached tibial bone plug. This may be important, especially in improving tibial graft fixation. This study encourages further research in tendon-bone healing with direct interference screw fixation to confirm the potential of this advanced method.
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A common problem for Emergency Room doctors on call is whether or not an arrested patient is sufficiently healthy to allow his transfer to jail. When there are signs of injury, or doubts about the patient's condition, the police must bring the patient in for medical examination to get a certification of the patient's health condition. He must be examined according to the information about his health and pre-existing conditions. ⋯ Additional documentation, such as photographic evidence must also be saved in the medical records. Should there be symptoms of a serious but difficult to diagnose condition, like traumatic head injury, the patient should always be admitted to the hospital. The medical certification or permission for imprisonment can not be enforced when the medical condition of the patient changes.