Unfallchirurgie
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A total of 285 children out of an 8 year period with fractures of the forearm were studied. Of these 175 (62.2%) had a fracture of the distal radius and 51 (18.2%) had a fracture of the distal forearm and there were 42 (14.7%) fractures in the middle or proximal third in this region. ⋯ In all cases the children were immobilized with a long upper arm cast for 3 to 4 weeks. Follow-up examinations up to 6 years after injury showed excellent results in distal forearm and distal radial fractures whereas results were only satisfactory in midshaft forearm fractures.
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Radiological investigations contribute little in differentiating the problems of patients with whiplash injuries. Nevertheless the more prolonged cases of whiplash injuries must not be attributed to preexisting degenerative disease, despite radiologically-proven medicolegal opinion. In this study, 60 patients who were seen for whiplash injuries in the Department for Trauma and Reconstructive Surgery at the University Hospital Hamburg-Eppendorf for clinical and radiological evaluation, an average of 5.7 years post injury, were divided into two groups (n = 30) depending on radiologically-proven preexisting degenerative changes of the cervical spine. ⋯ We are not able to differentiate the posttraumatic course from the natural history of the degenerative process, either clinically or radiologically. Considering the involvement of sensitive neurological structures the classical objective organic diagnosis of "whiplash injury" may not be adequate in describing the complaints of patients, and should not be used to justify the rejection of the patients subjective symptoms as mere simulation for financial gains. The evaluation of the patients' X-rays using Arlen's technique sheds no further light on the issue.
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Following the insertion of an intramedullary nail, the fat embolism is a frequent complication in patients with long bone fractures. The respiratory function of patients with fractures of the femur and accompanying severe chest injuries was improved. In general these patients have a high risk to develop a respiratory distress syndrome. ⋯ Four of them developed an ARDS (adult respiratory distress syndrome) up to grade IV for a period of 5 days. Two patients suffered an ARDS grade I for a period of 2 days. In the study no typical features of fat embolism syndrome were found in any of these patients.
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A combination injury to the forearm, consisting of Monteggia- and Galeazzi lesion is described. After osteosyntheses of the fractures the dislocation of the head of radius and ulna were reduced spontaneously because of restauration of correct axes and length. Because of a simultaneous fracture of the coronoid process an above elbow plaster cast was supplied. Healing took place with free motion of all joints.
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The risk of secondary osteoarthritis after proximal tibial fractures is influenced by the reconstruction of both the articular surface and associated knee ligament injuries. In a follow-up of 69 operatively treated tibial head fractures 36.2% revealed ligamentous damages. ⋯ Avulsion fractures of the knee ligaments can be successfully treated on by primary fixation. For ruptures of the medial collateral ligament a functional therapy is often sufficient whereas damages of the cruciate ligaments need secondary reconstruction.