[Ultrasound in diagnosis of traumatic intra-abdominal lesions. Value in primary diagnosis in the shock unit]. / Sonographie in der Diagnostik intraabdominaler traumatischer Läsionen. Stellenwert bei der Primärdiagnostik im Schockraum.

AIM: To evaluate sonography as a tool for initial diagnosis in emergency room patients with abdominal trauma. METHOD: 174 cases of abdominal trauma were selected from 1837 emergency care patients. The initial sonographic findings were compared to CT-evaluation, operative and autopsy results, and both clinical and sonographic follow-up. RESULTS: In 31 cases initial sonographic findings were positive, leading to 6 laparotomies. In another 6 cases, changes of follow-up sonographic testing led to laparotomy. In 143 patients, the initial sonographic evaluation was negative. In this group, follow-up evaluation revealed changes in 16 cases leading to 3 laparotomies. In 8 patients with stab injuries, the negative sonographic study was confirmed by operative findings. CONCLUSION: Sonography is a well-tested diagnostic method in evaluating patients with abdominal trauma. Follow-up examinations-even with negative initial results-are needed. While the time interval between evaluations depends on the individual risk factors, hourly reevaluation is generally appropriate.

[Power stapling in trauma surgery. An improvement of trauma surgery technique?]. / Die motorgetriebene Stapelung in der Unfallchirurgie. Eine Bereicherung unfallchirurgischer Technik?

Power staple fixation of fracture fragments represent an enrichment of technological possibilities in adaptive osteosynthesis. We gained some experience with a variety of indications. The advantage of this method can be seen in the simple and fast way of application. Observing limited indications excellent results can be achieved.

[Injury of the inguinal blood vessels in implantation of hip joint prosthesis]. / Verletzung der Leistengefässe bei Implantation von Hüftgelenkprothesen.

Vascular injuries during or after total hip replacements have often been reported. In 2257 artificial hip joint replacements, we observed 8 cases of vascular injuries requiring reconstruction (3 cases), suturing (2 cases), end-to-end anastomosis (1 case), or ligature (2 cases) performed by a vascular surgeon. A separate skin incision for vascular repair was necessary in all patients. Most of the injuries occurred as a result of technical errors through lack of caution when using bone hooks or rough handling, resulting in dislocation of the hip joint. The latter occurs mainly in revision procedures. Six patients recovered fully, but two died, one of hemorrhagic shock and the other of cardiac decompensation.

[Treatment of flake fracture of the talus]. / Zur Behandlung der flake fracture des Talus.

This is a report on 18 osteochondral lesions of the talar dome after sprained ankles and ruptured lateral collateral ligaments of the ankle. They were classified according to Berndt & Harty. The treatment of choice in recent flake fractures is the reduction and glueing with fibrine. Very good results were obtained according to Weber. The recommended treatment of ancient flake fractures frequently occurring to elder patients is the removal of the fragment and the drilling of the subchondral bone.

[Follow-up study of femoral shaft fractures in children (author's transl)]. / Spätergebnisse nach der Behandlung von kindlichen Oberschenkelschaftbrüchen.

Out of a series of 117 children (age 0-14 years) with femoral shaft fractures 65 patients were followed-up at an average of 10 years after injury. Examination was performed with special regard to torsion deformities and complaints or roentgenologically detectable prearthrotic changes. Individual differences in anteversion angle were found frequently, but there was no correlation to any complaints. The average anteversion angle of all injured and of all non injured femurs showed no difference and all values were found to be in physiological range. Our long-term results indicate, that unilateral wire traction is a sufficient way to obtain excellent results in the treatment of femoral shaft fractures in children.

[Pathological fractures of long medullary bones due to malignant tumours: indications for osteosynthesis (author's transl)]. / Pathologische Frakturen langer Röhrenknochen bei bösartigen Tumoren: Indikation zur Osteosynthese.

51 cases of pathological fracture, mostly due to metastatic malignant tumours, are reviewed in respect to the methods and results of operative treatment. These results are compared with those of other authors. It is found that resection of the tumour and osteosynthesis combined with the use of bone cement is the best way of treatment to relieve the patients of pain, mobilize them as soon as possible and improve the quality of their short, remaining lifespan. Despite the positive approach towards operative treatment there are some limiting findings which indicate that an operation should not be undertaken in those patients whose estimated survival time is less than the time of recovery and mobilization.

Achilles tendon repair with the plantaris tendon compared with repair using polyglycol threads.

Therapeutic results in 56 surgically treated patients with rupture of the Achilles tendon are presented. Results with repair using plantaris tendon and by suture of polyglycol threads are compared in 41 patients in a long-term followup study. Although 54 patients returned to their pre-accident physical activity, in all cases residual phenomena like calf atrophy, thickening of tendon, and tendon excursion were analyzed. The use of synthetic absorbable threads shortens the convalescence period. Covering the repair site with the fanned plantaris tendon seems to help to avoid painful adhesions with the skin.

[Blood supply of the scaphoid bone of the hand]. / Blutgefässversorgung des Handkahnbeins.

For investigation of the vascular supply of the os scaphoideum we produced post mortem injection specimens of hands with latex milk. The estraosseous vessels were prepared macroscopically and microscopically. The intraosseous vascular distribution was represented by cleared specimens (Spalteholz technique). A branch of the arteria radialis or of the ramus dorsalis arteriae radialis enters the dorsal face in the middle and distal third by several foramina nutricia. This artery effects the blood supply almost completely. Other vessels entering the navicular bone are small calibrated and only sometimes demonstrable. The proximal third of the scaphoideum shows no artery entrance.

[Behaviour of pertrochanteric fractures of the femur after condylar nailing under dynamical stress (author's transl)]. / Das Verhalten mit Federnägel versorgter pertrochanterer Oberschenkelbrüche unter Belastung

In continuation of our studies on dynamic tolerance after condylar nailing in pertrochanteric fractures, we have examined the femora of patients who died within the first 2 weeks after surgery and studied their stress tolerance. We appreciated the lack of the weight bearing medial cortical bone and the need for abduction at the fracture site by the behaviour under stress. The results under stress could be compared with an experimental fracture model. From these experiments conclusions have been made for the correct placement of condylar nails for their best static advantage.

[Complications in modern treatment of posttraumatic osteomyelitis (author's transl)]. / Komplikationen der modernen Osteomyelitistherapie

Several conditions must be accomplished for successful treatment of posttraumatic osteomyelitis, as there are stability in fracture region, surgical debridement, wound irrigation, cancellous bone transplantation and skin grafting. All this surgical methods involve possibilitis of complications. The most of them can be avoided observing certain rules of management.

[Stress tolerance of different osteosynthetic procedures in pertrochanteric fractures (author's transl)]. / Die Belastbarkeitsgrenze verschiedener Osteosynthesen pertrochanterer Oberschenkelfrakturen

To obtain valid information on stress tolerance of pertrochanteric fractures, we exposed three different methods of osteosyntheses to dynamical stress and the results were compared. The methods of osteosyntheses were application of a 130 degrees angle plate, performing an adjoining osteosynthesis with bone cement or using cephalocondylar nails. The measurements in connection with photographical and roentgenological examinations of osteosyntheses under stress gave the following results: Compared with the other methods treatment with condylar nails gave equal results in static behaviour yet was clearly superior in its dynamic reaction.

[Experiences with AO-semitubular plate in the stabilization of ankle fractures]. / Erfahrungen mit der AO-Drittelrohrplatte bei der Stabilisierung von Aussenknöchelfrakturen

Anatomical restoration of the lateral malleolus in ankle dislocation fractures is known to be very important. With the AO-small semitubular plate an armamentarium is available which accomplishes this task very well. Exercising stability nearly always can be attained. In case of postoperative infection, healing generally takes place without plate removing and, therefore, under good fracture position.