Experimental investigations about the stability of the spongiosa of the femoral head, a new angle plate in mind

Im Hinblick auf den Trochanter-major-Abbruch bei und nach Winkelplattenosteosynthesen von pertrochanteren Frakturen wurde zu Versuchszwecken eine 130o-Winkelplatte mit lediglich 6 mm breitem Klingenprofil angefertigt, bei der das notwendige Knochenfenster die laterale Femurkortikalis weniger schwacht. Die Fragestellung war, ob diese Plattenklinge hinsichtlich der Tragfahigkeit des Osteosynthesesystems vergleichbar stabil in der Spongiosa des Huftkopfes verankert werden kann wie die herkommliche 130o-Winkelplatte. Dazu wurden an Knochenpraparaten vergleichende Druckbelastbarkeitsversuche, von pertrochanteren Osteotomien durchgefuhrt. Die Ergebnisse zeigen, das die neuartige Klinge mit dem sc…

Der HEPFIEx-Simulator, eine Apparatur zur Bestimmung der Reibzahlen zwischen Hüftkopf-Prothesen und Knorpel / The HEPFlEx Simulator, a Device for Measuring the Friction between Femoral Head Prostheses and Cartilage

We describe a device designed to investigate friction between various femoral head prostheses and human acetabula. It enables not only the determination of friction and the relevance of the play between the femoral head and acetabulum, but also the evaluation of the kinematic behaviour of bipolar prostheses. In the simulator, the various femoral head prostheses are placed on a special cone and tested against a human cadaveric acetabulum. The swiveling range of the device is uniaxial, and the swiveling angle is +/- 35 degrees. The maximum force produced pneumatically is 5kN. Testing of the simulator with a TEP was successful and friction-coefficients of < 0.1 were measured, as are reported i…

Pathogenesis and prophylaxis of circulatory reactions during total hip replacement

Circulatory reactions such as a drop in blood pressure, bradycardia, cardiac arrest, and even intraoperative death after insertion of the stem are well known events during total hip replacement. The present paper reports bone marrow intravasation after rise of intramedullary pressure in the femoral cavity during insertion of hip prostheses, demonstrated by intraoperative transesophageal echocardiography. In an animal study, the ultrasound echoes were identified as "mixed emboli" consisting of a core of bone marrow surrounded by thrombus. These results suggested the use of an intramedullary plug to restrict the intravasation of bone marrow. A trial was undertaken in 60 total hip replacement …

Die intraoperative Sonographie des Wirbelkanals — Experimentelle Standardisierung und erste klinische Erfahrungen

Die dorsale operative Stabilisierung von Wirbelfrakturen, vor allem des thoracolumbalen Uberganges, mit einem Fixateur interne ist ein etabliertes Verfahren der Traumatologie. Das Ziel ist hier neben der Aufrichtung der Kyphose und der Wiederherstellung der Wirbelkorperhohe die Dekompression des Myelons durch die Reposition von Knochenfragmenten, die von der frakturierten Wirbelkorperhinterkante in den Spinalkanal hineinragen. In vielen Fallen gelingt die indirekte Reposition der Hinterkante alleine durch Kyphosekorrektur und Distraktion. In anderen Fallen mus der Wirbelkanal durch Laminektomie freigelegt und die Hinterkante direkt reponiert werden. Die Moglichkeiten, den Erfolg des Reposit…

Hypothenar hammer syndrome in sports

Repetitive blunt trauma or single severe trauma to the hypothenar region may lead to traumatic thrombosis of the distal ulnar artery (hypothenar hammer syndrome, HHS). In the sports-related literature we found and analysed isolated cases attributed to injuries sustained during sporting activities such as baseball, badminton, handball, football, frisbee, softball, karate, weight-lifting and hockey. Further, we report the case of an amateur golf player with ischaemic symptoms of his left hand, where angiography revealed filling defects in the digital arteries associated with a corkscrew-like configuration of the distal ulnar artery. Magnetic resonance imaging (MRI) scan demonstrated, at the l…

Hypothenar Hammer Syndrome in a Golf Player: A Case Report

Der intramedulläre Druck während Marknagelosteosynthesen

In einer Sammelstudie der AO fand ECKE (1) 1 985 bei 1 257 Marknagelosteosynthesen wegen isolierter Femurfraktur in 4% der Falle schwere pulmonale Komplikationen wie Fettembolie, Lungenversagen und Pneumonien. Die pulmonale Komplikationsrate war bei den unter dreisigjahrigen primar operierten Patienten ebenfalls 4%, so das altersbedingte Risikofaktoren als alleinige Ursache ausscheiden.

Grundsätzliche Überlegungen zur Problematik der Abbrüche des Trochanter major bei und nach Winkelplattenosteosynthesen

Intra- und postoperative Abbruche des Trochanter major bei der operativen Versorgung von pertrochanteren Femurfrakturen sind keine Seltenheit. In der vorliegenden Arbeit werden die wichtigsten Ursachen dargelegt und Empfehlungen zur Vermeidung dieser Komplikationen gegeben. Ein wichtiger Kritikpunkt beim operativen Zugang ist die allgemein empfohlene, aber vollig uberflussige L-formige Abtrennung des M.-vastus-lateralis-Ursprunges. Den entscheidenden Schwachpunkt stellt jedoch das fur die Einbringung der Implantate notwendige grose Knochenfenster in der lateralen Femurkortikalis dar.

Der Sicherheitsgurt: Auswirkungen auf das Verletzungsmuster von Autoinsassen

Since 1984 the law concerning safety belts has been implemented; this paper deals with the findings in 386 victims of motor accidents who were x-rayed between 1981 and 1989. Minor injuries have been ignored. The number of passengers wearing belts increased by 30% after 1984. The number of passenger injuries did not decrease. Injuries directly caused by the belts included a small number of fractures of clavicles, the sternum and ribs and one pelvic fracture, one serious abdominal injury with tearing of the mesenteric artery and one ruptured spleen. An indirect result of wearing seat belts was a marked increase in cervical whiplash injuries and some increase in thoracic vertebral fractures. N…

Langzeitergebnisse nach Versorgung medialer Schenkelhalsfrakturen mit Keramikkopfendoprothesen

Total hip replacement is often recommended for the treatment of femoral neck fractures in elderly patients. A less invasive approach with shorter operating time is the replacement of the femoral head only, leaving the acetabular cartilage in situ. Hemiarthroplastic hip replacement using a metallic head prosthesis was not successful in the past, because the majority of patients developed protrusio acetabuli after surgery. In the present study hemiarthroplastic hip replacement using an Al2O3-ceramic head was shown to be a useful method for the treatment of femoral neck fractures in elderly patients. From 1985 to 1990 277 patients were treated with hemiarthroplasty. The average age at the time…

The efficiency of lead thyroid shield in trauma surgery

Die Strahlenbelastung der Operateure bei unfallchirurgischen Eingriffen hat in den letzten Jahren durch den Trend zu biologischen Osteosyntheseverfahren, insbesondere der Marknagelung, zugenommen, da geschlossene Reposition und distale Verriegelung radiologisch kontrolliert werden. Wir wollten jetzt uberprufen, welchen Einflus der Schilddrusenbleischutz auf die Strahlenbelastung der Operateure bei operativen Eingriffen an den unteren Extremitaten hat. Mit Hilfe eines Unterschenkelphantoms wurden unterschiedliche intraoperative Durchleuchtungssituationen simuliert und die Strahlenbelastung der Schilddruse mit und ohne Bleischutz des Operateurs uber ein Dosismesgerat (Szintomat) festgestellt.…

Long-term results after operative treatment of femoral neck fractures with ceramic head prostheses.

ABSTRACT From 1 985-1 990, a total of 277 elderly patients underwent hemiarthroplasty using a ceramic head prosthesis. Average patient age was 81.7 years. Of these, 77 patients were available for follow-up examination in 1993. A standardized score was calculated assessing activity, gait, and hip pain; the average score was 58 out of 78 possible points. Three patients had hip pain, and in 4 patients, radiographic examination revealed protrusio acetabuli. Two of 4 patients underwent revision surgery for replacement of the cup, leaving the stem in situ. Because of the small number of prosthetic-related complications, hemiarthroplasty using a ceramic head prosthesis is the recommended surgical …

Treatment of femoral fractures after hip prosthesis

Im Zeitraum von 1995 bis 1997 wurden in unserer Klinik 24 huftprothetische Operationen durchgefuhrt mit Implantation eines Prothesenspezialschaftes aufgrund erheblichen Knochenverlustes sowie aufgetretener Frakturen des proximalen Femurs. Bei sechs Patienten erfolgte ein primarer Prothesenwechsel, sechsmal lag bereits praoperativ eine Femurfraktur bzw. eine Fraktur der bisherigen femoralen Prothesenkomponente vor, bei funf Patienten war es im Rahmen der Wechseloperation zu Frakturen gekommen. Pathologische Frakturen lagen funfmal vor, einmal erfolgte beim Prothesenwechsel eine femorale Korrekturosteotomie, einmal wurde eine Pseudarthrose bei implantierter Prothese behandelt. Defekte des Ace…

Experimentelle Untersuchungen zur Schwächung der Stabilität des Trochanter major durch laterale Fensterung

Ubliche 130°-Winkelplatten zur Versorgung huftgelenknaher Femurfrakturen haben den Nachteil, das durch das breite Einschlagfenster die laterale Femurkortikalis an biomechanisch wichtiger und hoch beanspruchter Stelle weitgehend unterbrochen wird; dies fuhrt haufig zu Komplikationen wie Abris des Trochanter major, mangelnde Stabilitat usw. Bei anderen Osteosyntheseverfahren, zum Beispiel der dynamischen Huftschraube, wird ein rundes Loch gebohrt. An zehn Femurpaaren wurde experimentell die Minderung der Stabilitat objektiviert, die durch die laterale Fensterung fur eine Osteosynthese entsteht, wobei die rechteckige Fensterung fur Winkelplatten und die kreisrunde Fensterung fur die dynamische…

Reaction of the bone structure to methotrexate-Palacos flow y. Experimental investigations in animals.

With the combined osteosynthesis of pathological fractures in association with tumors and/or metastases in mind, E. Merck (Darmstadt, FRG) developed a bone cement containing a cytostatic agent, methotrexate-Palacos flow y (MTX-Pf). The animal-experimental study presented here investigates the tolerability of MTX-Pf in the femurs of rabbits with lateral comparison. In these investigations we used both the concentration of 0.63% MTX, as is currently used in standard clinical surgery, as well as a much higher concentration of 2.5% MTX. The histological sections were investigated using microradiographic methods and provided no indication of any significant differences between the femora with th…

Transverse sacral fracture with intrapelvic intrusion of the lumbosacral spine: case report and review of the literature.

Is there still an indication for operative treatment of femoral neck fractures with a ceramic hemiprosthesis?

From 1985 to 1995, 417 patients with dislocated medial femoral neck fractures (Garden III–IV) were treated with hemiarthroplasty using a Biolox ceramic head. The average patient age at the time of operation was 81.5 years. A total of 140 survivors was available for follow-up examination with a mean prosthesis longevity of 55.8 months. The Harris hip score recorded a mean of 70.6 points. At the time of follow up, 5 patients had severe hip pain, and in 8 the roentgenographic examination revealed protrusio acetabuli. Five of these 8 patients underwent revision surgery for replacement of the cup, leaving the stem in situ.

Ergebnisse nach primärer ungebohrter Tibianagelung von Unterschenkelfrakturen mit schwerem offenem oder geschlossenem Weichteilschaden

Primary stabilization was performed in 72 tibial fractures with sever open (n = 37) or closed (n = 35) soft tissue injury using unreamed interlocking nails. In 60 (83%) cases the fractures healed without additional procedures. There were 2 cases of osteitis, but both these fractures healed after removal of the nail or after reamed nailing. In 9 patients with delayed union reamed nailing (n = 8) or bone grafting (n = 1) led to healing. In 1 patient with hypertrophic pseudarthrosis, union was achieved after substitution of a reamed nail for the anreamed nail. The infection rate was similar to that observed with external fixation. More secondary procedures, such as bone grafting or a change of…

Ultrasound-guided spinal fracture repositioning

The management of narrowing spinal fragments in the operative treatment of spinal fractures remains an open question, in particular when the procedure is performed by a posterior approach. This article describes the use of intraoperative ultrasonography during spinal surgery. From 1990 to 1997, 116 spinal fractures were treated operatively at our clinic. Stabilization of the spine was achieved with the AO fixateur interne and the AO USS, respectively (Synthes, D-79224, Umkirch, Germany). For 60 cases who had a fractured posterior vertebral surface dislocated into the spinal canal, we used intraoperative ultrasonography to monitor the repositioning of the narrowing fragments. The patients un…

Dynamic angular three-dimensional measurement of multisegmental thoracolumbar motion in vivo.

Study design Method validation and in vivo motion segment study. Objective To determine in healthy subjects in vivo intervertebral segmental kinematics and coupled motion behavior in all 3 planes simultaneously for 3 segments and to evaluate whether these results differ from those in the normal population according to the literature. Summary of background data Few studies have provided a direct invasive approach to investigate segmental kinematics in vivo. Dynamic recordings of 3-dimensional segmental motion patterns of adjacent segments have rarely been reported. To date, no studies have examined the 3-dimensional segmental movements of the thoracolumbar junction in vivo in detail. Methods…

Pigmented villonodular synovitis of the shoulder: review and case report

Pigmented villonodular synovitis (PVNS) as reviewed in detail elsewhere most frequently involves the knee and finger synovial structures; shoulder involvement is rare: A search through the English literature yielded 18 publications describing 25 cases of PVNS affecting the shoulder joint. Analyzing these reports we found the clinical and radiological findings generally to be nonspecific, often mimicking a malignancy, as in the case presented here of a 16-year-old boy with painful swelling in the area of the left proximal humerus. Magnetic resonance imaging showed a suspected malignant soft tissue mass involving the shoulder capsule and measuring 7.5 x 6 x 4 cm. Preoperatively the patient co…

Endoscopic carpal tunnel release: results with special consideration to possible complications.

Single-portal endoscopic carpal tunnel release (Agee technique) was carried out in 148 patients. Of these, 100 were examined clinically and electrophysiologically 1 day before surgery and 1 and 3 months thereafter. Ten patients experienced transient ulnar neuropraxia and two patients complained postoperatively of intense pain in the middle and ring fingers. Three patients suffered residual symptoms. In one of these an incomplete release of the distal portion of the retinaculum flexorum was suspected and later confirmed by magnetic resonance imaging. Another patient had applied for pension due to problems associated with a vertebral fracture in addition to his carpal tunnel symptoms. A third…

Minimally invasive plate fixation in femoral shaft fractures

Bridge-plating with its advantages in terms of vascularity and bone healing is a well established procedure today in the treatment of comminuted femoral fractures. Bridge-plating means that the fracture site is not interfered with during the operative procedure. This paper introduces a surgical technique in which the plate is inserted through isolated proximal and distal incisions only, behind the vastus lateralis. Alignment is secured by the plates, the fracture site remains untouched, fixation and screw insertion is restricted to the proximal and distal main fragments. Longitudinal femoral fractures extending right into the trochanteric and or condylar areas are the main indication for mi…

Ergebnisse nach Implantation von zementfreien metallspongiösen Hüftprothesen

72 Huftgelenke mit zementfreier metallspongioser Huftprothese wurden zwei bis sieben Jahre (mittlere Nachuntersuchungszeit 43 Monate) nach der Implantation klinisch und rontgenologisch kontrolliert. Bei funf Patienten muste die zementfreie Prothese wegen Lockerung (ausbleibende knocherne Einheilung n=2, Pfannenlockerung infolge operationstechnischer Fehler n=3) gewechselt werden. Aufgrund der klinischen Befunde konnten 88% von 67 Huften mit sehr gut bzw. gut, 9% mit befriedigend und 3% mit unbefriedigend bewertet werden. 10% der Patienten klagten noch uber Oberschenkelschmerzen. Die typischen, rontgenologisch erkennbaren, knochernen Reaktionen des Implantatlagers werden beschrieben, eine In…

Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing — demonstrated by intraoperative echocardiography

Abstract For the clarification of pulmonary impairment after medullary nailing of femoral fractures, the intramedullary pressure in the femoral cavity during the operative procedure was investigated. In addition, an intraoperative transoesophageal echocardiography was performed which revealed two phenomena occurring once the intramedullary pressure had increased: snow-flurry and configured emboli. An experimental study in sheep was performed in order to define the substrata of the sonographic echoes. The level of intrafemoral pressure which would result in bone marrow intravasation and the substrata of the echocardiographic echoes were studied in sheep by applying pressure to the femoral ca…

Hypothenar Hammer Syndrome in a Golf Player.