Archives of orthopaedic and trauma surgery
-
Arch Orthop Trauma Surg · Jan 1999
Weight-based heparin dosing is more effective in the treatment of postoperative deep vein thrombosis.
Rapid clinical diagnosis and adequate treatment are the major determinants of successful therapy of deep vein thrombosis (DVT). In the initial treatment of DVT, heparin is the anticoagulant of choice. Appropriate heparin dosing is of major interest concerning the onset of therapeutic anticoagulation and, thus, the clinical outcome of the patients. ⋯ In group one (patients treated with the weight-based heparin nomogram) the therapeutic range (partial thromboplastin time 1.5-2.3 times the control) was reached on average within 24 h (75% of the patients); 95% of the patients reached the therapeutic range within 48 h. In group two (patients treated with the standard heparin nomogram) the therapeutic range was reached on average within 48 h (60%; 30% of the patients reached the therapeutic range within 24 h). The used weight-based heparin nomogram has proved to be effective, safe and superior to one based on standard practice concerning the time elapsed between initial heparin therapy and achieving the therapeutic range for intravenous anticoagulation.
-
Arch Orthop Trauma Surg · Jan 1999
Self-locking tension band technique. A new perspective in tension band wiring.
After experiencing some complications with the AO modified tension band technique, we have made a small modification to prevent proximal migration of the Kirschner wires. In this modification, the proximal ends of the wires are bent to form a loop and the cerclage wire passed through them. In this way, Kirschner wires and cerclage wire lock each other, preventing migration. ⋯ Fracture union occurred in 8 weeks (mean). We did not see any postoperative complications or implant failures. Rigid fixation allows early mobilization which quickly restores functional status.
-
Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialProspective randomized comparison of gliding nail and gamma nail in the therapy of trochanteric fractures.
In a prospective randomized study, we compared the new intramedullary implant of the gliding nail to the gamma nail in the fixation of 80 unstable trochanteric fractures in elderly patients. The preconditions of both groups were comparable. ⋯ Also, the anatomic reconstruction and the long-term function according to the Merle d'Aubigne score were comparable. Regarding postoperative complications, the gliding nail showed a minor tendency of cutting out; this we attribute to the special design of the dynamic blade and regard it as the most favourable advantage of this new implant.
-
Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialPain therapy following joint replacement.A randomized study of patient-controlled analgesia versus conventional pain therapy.
A prospective randomized trial in 42 patients undergoing elective total hip or knee arthroplasty under general anaesthesia was carried out to evaluate the efficacy of patient-controlled analgesia (PCA) versus demanded conventional pain therapy (CPT) for controlling postoperative pain. Four patients had to be excluded from the study (2 postoperative confusion, 1 elevated piritramid dosage caused by chronic pain therapy, 1 stressed by PCA pump handling). PCA group (n = 19) received piritramid via PCA pump, CPT group (n = 19) received tramadol (oral or intramuscularly) or piritramid intravenously. ⋯ The PCA group required on average twice as much piritramid-equivalent than the CPT group (P < 0.001). Patient satisfaction was good in both groups, but significantly better in the PCA group (P < 0.01), although the measured postoperative individual pain scores were above the preoperatively determined individual subjective pain threshold in the majority of both groups. From these results we draw the conclusion that even if the patients feel satisfied by the pain therapy administered, the majority are objectively treated below their individual subjective pain threshold.
-
Arch Orthop Trauma Surg · Jan 1999
ReviewPrevalence of popliteal cysts in children. A sonographic study and review of the literature.
Popliteal cysts in children differ from those in adults. They are considered to be less frequent and usually appear in the absence of intra-articular lesions. However, their prevalence in asymptomatic children is unknown. ⋯ A popliteal cyst could be identified in 4 patients. The prevalence of asymptomatic popliteal cysts was thus 2.4%. For 2 of these patients, we obtained magnetic resonance image of the knee which showed no concommitant intra-articular pathology.