Der Unfallchirurg
-
Craniocerebral missile injuries are a relatively rare type of head injury during peacetime. In the Department of Neurosurgery of the Landesnervenklinik Salzburg 72 patients were operated on for gunshot wounds of the brain in the period 1970-1990, and 31 survived. In the same period 6763 patients were treated for other head injuries. As shown by the clinical courses and the operative results, the velocity and thus the extent of the primary brain damage determine the prospects of success in the treatment of cerebral missile injuries.
-
Compared with proximal ruptures of the biceps sinew, distal ruptures of the biceps sinew are extremely rare and generally need operative treatment. However, the large number of different operation techniques described in literature clearly shows that a safe method of treatment has still not been found. In the "Bergmannsheil" Hospital in Gelsenkirchen-Buer, 11 distal ruptures of the biceps sinew in 10 patients were operatively treated during 1985 and 1989. ⋯ In the course of follow-up examinations we noted a considerable deficit of supination power remaining in the affected lower arm, although the clinical results were good otherwise; we have therefore developed our own method, taking particular account of the essentially more important function of the biceps brachii muscle as a supinator in addition to its flexion function. The method applied is described. At the follow-up examination distinctly better supination power was noted in the 4 patients operated on by this method; the flexibility of the cubital joint was not reduced.(ABSTRACT TRUNCATED AT 250 WORDS)
-
In the Department of Surgery in the University Hospital "Bergmannsheil" in Bochum, 67 patients with unstable injuries of the thoracic and lumbar spine were analyzed in a retrospective study. The sagittal correction loss was greatest about 6 months after dorsal stabilization--6 degrees on the average--after stabilization with a plate alone. The correction loss after stabilization with plates combined with the Universal Spine Instrumentation System (USIS), which was developed for ventral derotational spondylodesis or after implantation of an internal fixation device, however, amounted to 3 degrees on the average. ⋯ This occurred equally often with all types of implants. Efficient use of the three systems is discussed with regard to the different pathomechanical modes of injury. A causative scheme of treatment is presented.
-
Comparative Study
[Femoral head preserving therapy in medial femoral neck fractures. A clinical study of the effects of treatment method on the outcome].
The main problem with fractures of the femoral neck is the high incidence of avascular necrosis and non-union. While the rate of pseudarthroses has been lowered by treatment with stable compression screws, no effect of this technique on the incidence of head necrosis is evident. The reasons for this are rupture of vessels, wide dislocation of fragments and diminution of blood supply owing to intracapsular hematoma. ⋯ With the opening of the capsule and evacuation of the hematoma pressure on the blood vessels is relieved. The analysis of data recorded in 81 patients treated with open reduction and stable internal fixation revealed that poor functional results and avascular necrosis occur especially in fractures of Garden's stages III and IV that are operated on longer than 6 h after the trauma is sustained. Therefore, the operation should be performed as soon as possible as an emergency procedure to reduce the likelihood of such severe complications.