Der Unfallchirurg
-
Owing to advances in adjuvant therapy, the outlook for patients with primary malignant bone tumors has improved dramatically in recent decades. This applies both to improved survival and to increased limb salvage rates. ⋯ The use of soft tissue procedures such as flaps and the use of modular implant systems has reduced the complication rates of limb salvage procedures. In the future we hope to further improve prognosis and quality of life for such patients by the application of risk-adapted strategies for chemotherapy and surgery.
-
Fractures of the elbow joint are quite rare compared with the total incidence of injuries to the extremities. However, elbow fractures often result in significant disability. Therefore in a retrospective study, we have evaluated criteria that are of prognostic value for late functional outcome. ⋯ An external joint transfixation resulted in a score of < 5 in 32% of patients that were treated primarily by transfixation. In cases initially treated with open reduction and internal fixation, only 18.5% of open fractures and 3.1% of closed fractures presented a similar low score. According to our results the late functional outcome of elbow fractures depends less on the type of fracture than on the presence of a nerve lesion and the method of primary treatment, which should facilitate early mobilization.
-
Case Reports
[Right-sided diaphragmatic rupture with intrathoracic displacement of the entire right lobe of the liver].
A case of rupture of the right hemidiaphragm resulting from blunt trauma with complete intrathoracic dislocation of the right hepatic lobe in a multiple trauma patient is presented. After a primary chest X-ray study had been interpreted as showing right-sided hemothorax, the thoracic drainage tube was accidentally placed into the liver. ⋯ Problems of diagnosis and operative procedure in rare cases of fresh right-sided blunt traumatic diaphragmatic ruptures are discussed. CT may be helpful in the differential diagnosis of pulmonary contusions, hemothorax and diaphragmatic disruptions with intrathoracic herniation of intra-abdominal organs.
-
The vascularity of the articular fragment is of key importance for the final outcome in three- and four-part fractures of the humeral head. Displacement of the articular segment may compromise the arterial blood supply to the humeral head and result in avascular necrosis. There is still controversy as to whether three-and four-part fracture dislocations (articular fragment outside the glenoid) have an even worse prognosis than displaced three- and four-part fractures. ⋯ In displaced three-and four-part fractures of the humeral head the dislocation of the articular segment does not seem to increase the risk of avascular necrosis, if treated by timely and careful ORIF with respect to the vascularity. Even with the increased risk of primary nerve and plexus lesions in fracture dislocations, good functional results can be achieved by early operative nerve decompression and fracture stabilization in this middle-aged patient group. However, older patients with displaced or dislocated four-fragment fractures through the anatomical neck (type C3) have a poor chance of a favourable outcome, and therefore primary prosthetic replacement should be considered.
-
The vascular anatomy in the acetabular region involves a certain risk of arterial and venous injuries complicating orthopaedic surgery. These complications have been grouped into four categories: lacerations, thrombosis, pseudoaneurysms and arteriovenous fistula. In a period of 5 years, three injuries of the external iliac artery and four lesions of the femoral artery associated with total hip arthroplasty were treated surgically at the Department of Vascular Surgery of the University Hospital in Graz. ⋯ Femoral vessels are endangered by Hohmann retractors that are not placed directly on bone. Though vascular injury during hip operations is rare, recognition of such complications is important as safe and satisfactory treatment can be achieved. Rapid identification and immediate surgical repair of these lacerations are essential for their management.