Der Unfallchirurg
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Techniques for operative treatment of supra- and intercondylar fractures have changed in recent years. Some of these changes have come about in reduction techniques and implant selection. ⋯ These techniques result in better operative visualization and management of intraarticular comminution, safer fracture healing and better functional outcome. New strategies and techniques for the avoidance of axial malalignment, rotational deformities and leg length discrepancies are described.
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Severely injured patients, in particular, benefit from initiation of endotracheal intubation and controlled ventilation before hospital admission. The most frequent and most serious mishap of this emergency procedure is inadvertent esophageal tube placement. A reliable and simple determination of proper tube placement involves capnometry, the measurement of carbon dioxide concentration during the respiratory cycle. ⋯ We conclude that the STAT CAP reliably detects tracheal placement of endotracheal tube in non-arrested patients. In the arrested patient, interpretation of CO2 nonappearance requires caution. In addition to the traditional clinical signs, semi-quantitative capnometry is a meaningful supplement to verify tracheal tube placement in the prehospital management of trauma patients.
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Comparative Study
[Various therapy concepts in severe fractures of the tibial pilon (type C injuries). A comparative study].
Between 1982 and 1992, 79 pylon fractures were treated with internal fixation as the primary treatment at the trauma department of the Hannover Medical School. In a retrospective study 71 patients were evaluated, and 51 of them were re-examined clinically and radiographically an average of 68 months after injury. The purpose of this study was to compare these different forms of surgical management concerning their long-term results: 1. ⋯ Although only closed fractures were treated primarily by internal fixation with plating no significant differences between the three groups were found in the classification of fractures and soft tissue damage. All but 4 fractures were type-C lesions according to the AO classification, and 19 patients sustained open injuries. The infection rate for minimal invasive internal fixation was significantly lower with a two-step procedure (group 3) than with the one-step procedure according to a suitable statistic test (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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There are two specific problems in using metallic or ceramic heads for hip prostheses: (1) the amount of polyethylene abrasions in the cup caused by the heads (especially a metal head). (2) the polyethylene abrasions caused by Al2O3 ceramic heads is far less than metal heads, but its ability to adapt geometrically is limited due to its being less strong. The abrasions appear because of geometric differences in the prosthetic joint, local problems in the surface architecture and physical/chemical interactions between the different materials. ⋯ Testing 2,000,000 cycles in a bodylike liquid under permanent loads of 90 kPa, periodically increasing up to 250 kPa, simulating normal stress situations (i.e., walking), the "Titan-Niob Ceramic Multilayer Sandwich Head" showed major advantages over the metal heads and also over the ceramic heads even though the ceramic head has been accepted so far to have the best friction coefficient. Furthermore, there has been no problem in surface fracture with the "Titan-Niob Ceramic Multilayer Sandwich Head".
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Case Reports
Avulsion of the anterior superior iliac spine in two adolescent sisters: operative versus conservative treatment.
We compared the results of treatment of identical injuries to the anterior superior iliac spine in two adolescent sisters, one treated conservatively and the other operatively. The functional results of both treatments were good, but the rehabilitation period was shorter with operative treatment, allowing an earlier return to athletic activity. Treatment by open reduction and internal fixation should be considered in patients requiring a short convalescence. Familial coincidence of avulsion fracture of the anterior superior iliac spine has not previously been described in the literature.