Unfallchirurgie
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Acute traumatic dislocation of the patella may be associated with osteochondral fractures. Clinical examination invariably shows a tense effusion. A detailed radiographic examination including antero-posterior, lateral and skyline views of the patella is usually necessary to establish an exact diagnosis. ⋯ In two cases medial transfer of the tibial tuberosity was carried out. Osteochondral fractures of the femoro-patellar groove represent an important injury in the course of acute patellar dislocation. With exact diagnosis and correct treatment congruity of the femoro-patellar joint can be restored in many cases.
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In this retrospective study about 101 patients, two groups of patients are compared in order to find out the most significant factors affecting survival after an acute, posttraumatic subdural hematoma (ASDH) of patients older than 60 years. Solitary ASDH in people older than 60 years showed an advantage in terms of survival. Additional traumas to the brain, chest or the blood circulatory system doubled the lethality rate of people older than 60 years. ⋯ A prognostic advantage on the contrary could be observed by patients older than 60 years whose ASDH was caused by a ruptured bridging vein. Most of the ASDH in older people occurred after falling down steps. Some patients fell according to an epileptic attack of an intracerebral bleeding after an anticoagulation therapy.
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In malignant pathological fractures, surgery is an essential part of the whole oncologic conception. In most cases it is combined with adjuvant therapies. ⋯ A very important point is the wish of the patient. With our low complication rates, we have been able to facilitate the hard fates of many patients even if they had only short survival times.
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Case Reports
[Perilunar dislocations and dislocation fractures in polytrauma patients--diagnosis and therapy].
Between 1978 and 1987 about 700 multiply injured patients were treated at the Department of Emergency Surgery (University Hospital Hamburg-Eppendorf). Seven of these suffered from injuries of the wrist, in detail six perilunar dislocations with fractures of the scaphoid and one dislocation of the triquetrum. In six cases the correct diagnosis was found primarily by clinical and X-ray examinations. ⋯ Early closed reduction and prolonged immobilization in casts. 2. In cases where closed reduction cannot be achieved open reduction, pinning (Kirschner-wires) and immobilization should be performed. 3. Fractures of the scaphoid are provided with screws.
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In the treatment of the capsular ligament lesions of the knee joint, the most important therapeutic measure is the reconstruction of the central pillar of the cruciate ligaments. 112 patients with ruptures of the cruciate ligaments and associated injuries have been operated from 1975 through 1985. 78 out of them can be checked-up. Most of the accidents are due to sports or professional activities. 76% of the patients are treated early, i.e. within the first six days from the accident. The rates of simple instabilities as well as of anteromedial rotation instabilities are 40% each, the remaining injuries are severe combined traumas to the knee. ⋯ In 89% of the cases, the articular stability is restored with very good or good success by reconstruction. A permanent instability is only observed in two patients. Taking into consideration the mobility and the subjective opinions of patients, 71% have very good or good results.