Der Unfallchirurg
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The aim of this study was to evaluate the results after open Bankart repair using suture anchors in patients with recurrent posttraumatic anterior shoulder instability. Some 32 patients were prospectively observed for a mean of 40 months (24-60) after stabilization. The mean age at the time of operation was 29.7 years. ⋯ Two patients (6.3%) developed recurrent instability 6-24 months postoperatively; 93.7% were not or only slights limited in sports activities. Bankart repair is an excellent treatment for recurrent posttraumatic anterior shoulder instability. The use of suture anchors is an appropriate way of reattaching the capsuloligamentous complex to the glenoid to restore stability to an unstable joint.
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Comparative Study
[Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures].
Tibial plateau fractures with depression of posterior aspects of the proximal tibia cause significant therapeutic problems. Posterior fractures on the medial side are mainly highly instable fracture-dislocations (Moore type I). Posterolateral fractures usually cause massive depression and destruction of the chondral surface. ⋯ Five of the 26 cases had revision surgery: 3 patients developed valgus or retrocurvatum deformity and were successfully treated by an osteotomy. They obtained a good result at follow-up. Two fractures in elderly patients were revised to an endoprosthesis.
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The purpose of this prospective study was to determine the early subjective and functional result and outcome after primary implantation of humeral endoprosthesis in severely comminuted humeral head fractures in elderly patients. From 1993 to 1995, 27 humeral head fractures (27 patients) were treated by primary implantation of a Neer II modular shoulder prosthesis. Of these, 23 patients were women, 4 patients were men. ⋯ The average Constant Score was 48 (25-76) points; the difference to the other shoulder was 30 (18-69) points. Of the 21 patients 19 were satisfied by the result and 20 would reaccept the same procedure. These preliminary results suggest that primary shoulder prosthesis in humeral head fractures in the elderly patient is a valuable alternative option.
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Comparative Study
[Quality management in early clinical polytrauma management. II. Optimizing therapy by treatment guidelines].
To enhance the quality of treatment of patients with multiple injuries (blunt trauma), guidelines for the acute clinical management (trauma-algorithm) were implemented at our clinic in 1994. The impact of these guidelines was analysed, comparing two prospectively recorded collectives of polytraumatized patients 4/1988-12/1993 (A; n = 126) and 1/1994-6/1996 (B; n = 74). Nine specifically defined parameters were used to assess the therapeutic process of early clinical trauma management. ⋯ In all groups a reduction of lethality could be shown for collective B: Group I, 0% vs. 20% (P < 0.05); group II, 8% vs. 24% (P < 0.05); and group III, 40% vs. 71%, not significant because of the small group in B (n = 5). The implementation of therapeutic management guidelines led to an improvement of both treatment processes and outcome. In order to regularly reassess validity and practicability of such guidelines as well as further enhance therapeutic quality, a continuous evaluation programme representing a quality management system should be inaugurated.
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A well-controlled, meticulous process has a far higher probability of resulting in a high quality of medical care than improvization and unstructured creativity. Algorithms display decision-making treatment processes and problem-solving strategies by giving clearly defined and formalized guidelines. The flow chart for decision-making follows the yes/no dichotomy of binary logic. ⋯ The use of algorithms allows a systematic search for errors in the process of quality management. In emergency situations they suggest a structured means of problem solving for the less experienced user. Algorithms are useful instruments in the teaching of medical decision-making.