Unfallchirurgie
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In tension band wiring different tensioners and wire-connections are in use. Both of these were examined on tensile force during and after connection with help of a material-testing machine. Additionally the different connections were examined under traction-load. ⋯ Further stretching causes plastic, i.e. irreversible deformation in monofilament wire and its connections. In twisted wires further tension stress causes ruptures especially at the border of the fixation clamp. In conclusion extreme active exercise of fractures treated with tension band wiring should not be emphasized.
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Cardinal symptom of the instability of thorax with paradoxical respiration is the irreversible respiratory insufficiency. The lethality is over 50%. For the treatment often besides the longterm respiration with the well known complications the operative stabilisation of the chest wall by osteosynthesis of the ribs by small plates. Thereby the mortality of this severe injury can be reduced significantly, if there is a good indication for osteosynthesis.
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While there is no doubt about the importance of early operation of fractures of the proximal femur in the very old the exact timing of the operation is still in discussion. Routine emergency operation is opposed to a carefully planned individual timing of surgery. ⋯ Hospital mortality was lowered from 18.9 to 9.1%. At the same time the rate of severe complications and the length of hospital stay were reduced significantly.
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Reflex sympathetic dystrophy can be elicited by various factors (e. g. trauma, herpes zoster, myocardial infarction). Independent of kind and site of a lesion, symptoms occur most often in the whole distal part of the affected extremity. There in most cases, a triad of autonomic, motor and sensory disturbances can be found clinically. ⋯ The most relevant pathomechanism in this process seems to be the occurrence of an imbalance between the activity of sympathetic vasoconstrictor neurons supplying arteries and those, supplying veins. A sympatholytic therapy, if applied in time, is able to cut off the vicious circle, which may lead to a restitutio ad integrum. Further investigations will show to what extent psychological factors are involved in developing the central nervous disturbance of the sympathetic nervous system and may also show if in addition the motor system is affected.
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The development and introduction of microsurgical technique has made possible completely new concept of revascularisation surgery in femoral head necrosis. The bone graft described in this presentation is a pedicled one from the lateral ilium. In five femoral head necrosis a pedicled corticocancellous pelvic graft, supplied by the deep branch of the superior gluteal artery, was transplanted in the femoral head. ⋯ Preoperatively and postoperatively performed selective angiographies are necessary and presented. In all cases an unimpeded perfusion could be shown three months postoperatively. Advantages and indications of the pedicled bone graft are discussed.