Zentralblatt für Chirurgie
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Periprosthetic femoral shaft fracture represents an uncommon but potentially devastating complication associated with total hip arthroplasty. The treatment should result in complete union of the fracture and at the same time guarantee stability of the implant. 15 patients treated between 1992 to 1998 were analysed. Clinical and radiographic follow-up averaged 30 months (6-79 months) in 13 cases. ⋯ The average Harris score was 70 (26-93). For fractures near the femoral stem or in case of implant loosening we recommend the shift to a long stem prosthesis. Also in fractures distally from the femoral stem tip we prefer now long stem implants rather than plate fixation to avoid large exposure of the femoral shaft and resultant complications.
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Aim of this study was to evaluate the importance of chest ultrasound and chest x-ray for the indication of thoracic drainage of pleural effusions in patients of an operative intensive care unit. Between December 1996 and June 1997 21 patients were included in a prospective trial in the operative intensive care unit. 26 thoracic drainages were used to drain pleural effusions. In all patients chest radiography in supine position and chest ultrasound were performed to assess the need of pleural drainage. ⋯ Considering both x-ray of the chest in supine position and chest ultrasound the correct indication to drain the pleural effusion was achieved in 25 cases (96%). In this prospective trial we compared chest ultrasound and chest radiography and demonstrated that ultrasound is more suitable to determine the amount of pleural effusions than radiography. In case of clinical and radiological suspicion on pleural effusion demanding for drainage a chest ultrasound should be performed to avoid underestimation of pleural fluid.
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Comparative Study
[Postoperative peripheral neuropathies in general surgery].
Postoperative nerve lesions beyond the operative area, the so called positioning traumas are considered uncommon in general surgery. But they can have serious consequences for the patient and the surgeon, including forensic sequelae. The objective of this work was to describe the incidence, pattern, risk factors and course of postoperative neuropathies in general surgery and to identify indicators to prevent these complications. ⋯ Nerve lesions caused by positioning can occur during any operation with any duration in general surgery. They should be avoided by thorough and careful positioning. Also the patient must be informed about the possibility of nerve lesions caused by the positioning.
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A report card system for fractures of the femur neck has been established at the department of external quality assurance of the chamber of physicians of Westphalia-Lippe since 1993. Since then several indicators of good quality have significantly changed: conservative treatment decreased from 6.8% 1993 to 4.2% in 1997, lethality decreased from 6.9% to 5.4%, average length of stay before operation decreased from 2.6 to 2.1 days, the frequency of operations on weekends increased, complications in wound healing increased from 4.9 to 6.0%, cardiopulmonary complications decreased from 11.2% to 7.8%. ⋯ Operative treatment was performed in more than 90% of all fractures in all counties of Westphalia-Lippe. However, there was a wide and significant geographical variation in the choice between osteosyntheses and hip replacement: the percentage of hip replacement differed between 57% and 82% among different counties.
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Osteotomy close to the knee is an established method to treat degenerative osteoarthritis of the knee with varus or valgus deformity. However, indications, surgical techniques and results are discussed controversially. ⋯ Supported by our results it is shown that osteotomy of the tibia for degenerative osteoarthritis together with operative arthroscopy in the same operative session gives better results compared to osteotomy alone. Despite the success of arthroplasty of the knee, osteotomy has it's place in the treatment of osteoarthritis.