[Bilateral acetabulum fracture after suffering sport trauma]. / Beidseitige Acetabulumfraktur nach erlittenem Sporttrauma.

This case study describes a 37-year-old male who suffered a bilateral transverse acetabulum fracture with a fracture of the posterior wall and a double-sided dorsal hip dislocation in combination with a left-sided femoral head fracture (Pipkin IV) while skiing in a "fun park". The accurate diagnosis and presurgical planning was made by means of a computed tomography (CT) scan and a subsequent 3D reconstruction. After a primarily executed shielded repositioning of the bilateral hip dislocationearly secondary and anatomical reconstruction of the double-sided acetabulum fracture was possible using the Kocher-Langenbeck approach. A consistent physiotherapy as well as rehabilitation finally led to a positive clinical result for the patient.

The reliability of a simplified Garden classification for intracapsular hip fractures.

BACKGROUND: The Garden classification is used to classify intracapsular proximal femur fractures. The reliability of this classification is poor and several authors advise a simplified classification of intracapsular hip fractures into non-displaced and displaced fractures. However, this proposed simplified classification has never been tested for its reliability. HYPOTHESIS: We estimate simplifying the classification of femoral neck fractures will lead to a higher inter-observer agreement. MATERIALS AND METHODS: Ten observers, trauma surgeons and residents, from two different institutes classified 100 intracapsular femoral neck fractures. The inter-observer agreements were calculated using the multi-rater Fleiss' kappa. RESULTS: The inter-observer kappa for the Garden classification was 0.31. An agreement of κ0.52 was observed if the Garden classification was simplified and the fractures were classified by our observers as 'non-displaced' or 'displaced'. No difference in reliability was seen for the use of the four-grade Garden classification as well as the simplified classification between trauma surgeons and residents. DISCUSSION: Classification of intracapsular hip fractures according to the four-grade Garden classification is unreliable. The reliability of classification improves when the Garden classification is simplified in a classification using the terms: 'non-displaced' or 'displaced'. LEVEL OF EVIDENCE: Level IV. Diagnostic retrospective study.

The Pauwels classification for intracapsular hip fractures: is it reliable?

The Pauwels classification for the femoral neck fracture is still broadly used in literature and clinical practise. However, this classification has never been tested for its reliability in terms of inter-observer agreement. We assessed whether or not it is reliable to use the Pauwels classification in pre-operative planning. Ten observers classified 100 intra-capsular femur fractures. The inter-observer agreement was calculated using the multi-rater Fleiss' kappa. The Pauwels classification showed an inter-observer agreement of κ0.31 (0.01). Classification of intra-capsular hip fractures according to the Pauwels classification using the Pauwels angle is unreliable and its use should be avoided.

[Clinical experiences and dosage pattern in subcutaneous single-injection digital block technique]. / Klinische Erfahrungen und Dosierungsrichtlinien beim einfachen subkutanen Fingerblock.

100 patients with injuries to their fingers were treated using the subcutaneous digital block as described by Low et al.. Different dosages ranging from 2 to 3 millilitres of a local anesthetic were required to obtain appropriate anesthesia according to the location of injury. 108 finger injuries were treated, 18 thumb injuries, 90 finger injuries. The anesthetic was administered using a 0.55 x 25 mm needle and injected strictly subcutaneously into the flexor crease at the base of the finger or thumb. Injuries to the palmar aspect of the fingers were anesthetized using 2 ml of a local anesthetic (1% Lidocain), whereas 3 ml were needed for sufficient pain relief in case of injury to the dorsal aspect of the fingers. Injury to the thumb required a higher dosage (3 ml subcutaneously), and only offered sufficient pain relief for palmar injuries. In the case of dorsal injuries, we found that this technique was not sufficient in providing pain relief. Additionally, we performed a deep local nerve block (Oberst), if the patient still felt discomfort or pain. The severity or type of injury did not play a role according to our findings. The subcutaneous finger block as described by Low et al., therefore, is the method of choice treating injuries to the fingers and to the palmar aspect of the thumb, since it offers a decrease in the amount of anesthetic required and increases patient comfort.

Post-traumatic cervical kyphosis in children cannot be prevented by non-operative methods.

Eleven children with a vertebral body flexion-compression fracture of the lower cervical spine were reviewed. Eight were treated non-operatively, two had a ventral interbody fusion and one a dorsal fusion. Follow-up time was 1 month to 12 years (mean 55 months). Following non-operative therapy six had a kyphotic deformity of more than 10 degrees at the last follow-up. Kyphosis cannot be prevented or cured by non-operative methods.

Late results following proximal reinsertion of isolated ruptured ACL ligaments.

Between 1982 and 1984, 49 patients with fresh isolated proximal ruptures of the anterior cruciate ligament (ACL) were operated on in the Trauma Hospital, Salzburg. The operation was performed within 1 week of trauma. The operational technique used was proximal reinsertion of the ruptured ACL alone. Postoperatively the knee was immobilized for 6 weeks in an above-the-knee plaster cast. We were able to re-examine 42 of the 49 patients 5-7 years after injury. In addition to a clinical examination, testing with a KT-1000 arthrometer was performed. The objective and subjective results we found were evaluated using the Lsyholm score and OAK knee evaluation form. We found 12 (29%) absolutely stable knee joints. We accepted a KT-1000 result of up to 3 mm as satisfactory, and 81% of our patients were in this category. The same percentage (81%) scored between 85 and 100 points on the Lysholm scale. Only 52% scored over 90 points on the OAK form. Subjectively only 6 patients (14%) were dissatisfied with their result.

[Value of plate osteosynthesis in treatment of radius fractures at a typical site]. / Stellenwert der Plattenosteosynthese in der Behandlung von Radiusfrakturen an typischer Stelle.

In the past, distal radius fractures tended to be treated conservatively. Recently, however, unsatisfactory anatomical and functional results have led to an increase in their surgical treatment. Our preferred method of treatment has been percutaneous pin fixation after closed reduction. In our opinion, open reduction and internal fixation with an A0-plate is indicated for Smith fractures (B3 A0-classification), and for any fractures which cannot be ideally reduced (usually C1 to C3 fractures). From 1972 until 1989, 84 patients with distal radius fractures underwent surgical treatment in the Unfallkrankenhaus Salzburg. The procedure was usually performed under brachial plexus or Bier block, and we preferred a palmarly positioned plate for internal fixation. Follow-up of 42 patients showed good results, the functional and subjective results earning higher marks than the X-ray findings.

[Bankart operation with the Mitek anchor system]. / Bankart-Operation mit dem Mitek-Anker-System.

We would like to introduce a new technique for the operation according to Bankart, incorporating a special system of refixation (Mitek-anchor-system). Up to now, Bankart's method is worldwide known as the operation method for correcting an anterior instability. The difficulties arising from the reinsertion of the capsula onto the glenoidal rim are responsible for the numerous modifications Bankart's method suffered. The Mitek-anchor-system makes a sufficient procedure available for the open refixation of the capsula. Stable reinsertion of the joint capsula onto the anterior glenoidal rim can be performed with considerably greater ease and simplicity than with the methods described by numerous other authors. The method is also excellently suited for the open suture of the limbus. We present our operation technique after 20 operations employing this method of refixation, and at the same time point out its indication, as well as its advantages over other conventional methods.

[Therapy of lunate necrosis]. / Therapie der Mondbeinnekrose.

Out of the multiple methods for treating Lunatum-malacia the following were used in our hospital: shortening of the radius, pisiform-transposition, cancellous bone graft, tendon interposition arthroplasty, intercarpal arthrodesis, prothetic replacement, wrist arthrodesis and denervation of the wrist. Because of non satisfactory results the conservative treatment was abandoned. The indication for one of the different operative methods depended on the radiological Decoulx-Stage, the profession and the age of the patient and his willingness to cooperate. From 1972-1988 36 patients with Kienböck's disease were treated in the Unfallkrankenhaus Salzburg. 20 were seen with an average follow up of 8.7 years. In the early stages of lunate necrosis with a minus variant of the ulna the best results were obtained by shortening of the radius otherwise with the pisiform transposition. The same results could be achieved in intermediate stages although with reservation for the pisiform transposition. Although the other operative methods gave pain relief and an improvement of grip strengths, they showed radiologically a progression of the necrosis. Denervation and wrist arthrodesis are reserved for stage IV. Despite some good results, new operative methods like revascularisation operations of the lunate bone seem promising.

[The diagnostic value of double contrast CT in shoulder dislocation]. / Diagnostischer Stellenwert des Doppelkontrast-CT bei der Schulterluxation.

The article reports of the indication, technique and results of the shoulder joint double-contrast-computertomography. It discuss its diagnostic value in comparison to other examining methods. As alternative preoperative diagnostic procedures only arthroscopy, arthrography and MRI can be considered. Also discussed are the therapeutic consequences resulting from the nature of the pathological lesions (rupture of the limbus glenoidalis, Hill-Sachs-defect, reversed Hill-Sachs-defect). Especially for the first traumatic dislocations of the shoulder joint, we consider this investigational method an eminent enlargement of the diagnostic spectrum. Therefore, we are generous with its indication, attempting to prevent reluxations by primary diagnostic and therapeutic procedure.

[Experiences with the treatment of Monteggia-type fractures in adults]. / Erfahrungen mit der Behandlung von Monteggia-Aquivalenten bei Erwachsenen.

Early results obtained in 23 Monteggia-type fractures were analysed. Osteosynthesis of the fracture of the ulnar shaft has to be carried out according to the art. Application of a plate on the radial or the ulnar side always leads to secondary angulation. If primary resection of the radial head is carried out poor results must be expected. The fractured radial head should be reconstructed, replaced by an implant, or at least left in place until the fracture of the ulna is consolidated. In Monteggia type-I/6 fractures the coronoid process must be reliably stabilized. Conservative treatment is inadequate for Monteggia-type fractures.

[Decrease in disability pension following replantation]. / Minderung der Rentenhöhe nach Replantationen.

Between 1977 and 1986, 201 patients underwent replantations at the Accident Hospital in Salzburg. Of these 201 cases, 112 (55.7%) were work-related accidents. The first 47 cases were evaluated by two independent experts, comparing the actual occupational disability, i.e. impairment of earning capacity after replantation with the probable occupational disability payment had the replantation not been performed. In thirty-nine out of forty-seven cases, replantation had led to lower disability benefits.

[Economic aspects of replantation surgery]. / Wirtschaftliche Aspekte bei der Replantationschirurgie.

Between 1977 and 1986 201 patients were treated by a replantation. 89 (44.3%) had a work accident. In order to find out the change in renumeration payed by the insurance company, 47 were seen at an follow up. They all had had a working accident and were insured by the "Allgemeine Unfallversicherungsanstalt, Landesstelle Salzburg". We compared the lifetime difference of degree of disablement with and without replantation. An average diminuation of rentpayment between 5 to 25% per patient was found after successful replantations.

[Malunion and growth disorders following fractures of the condylus radialis humeri in children]. / Fehlheilungen und Wachstumsstörungen nach Frakturen des Condylus radialis humeri im Kindesalter.

Basing on the results of 46 fractures of the lateral humeral condyle in children possible mal-unions and disturbances of growth after conservative and operative treatment are shown. Varus-tendency of the elbow axis was observated in 23% after conservative treatment of undisplaced fractures and in 37.5% after open reduction and Kirschner wiring of displaced fractures. Fish-tail deformity was seen both after conservative treatment and fixation with Kirschner wires; only open reduction and osteosynthesis with small-fragment screws could avoid this two disturbances of growth. One non-union was seen after conservative treatment.

[Surgical treatment of forearm shaft fracture]. / Die operative Behandlung der Unterarmschaftfraktur.

Between 1977 and 1987 at trauma hospital in Salzburg 142 patients with shaft fractures in the middle third of forearm have been treated by open reduction (altogether 730 forearm fractures in the same period). Among other things post surgical complications are examined. Functional results and reported troubles of patients are demonstrated by 66 cases which have been reviewed.

[Comparative study of arthroscopic and open meniscus surgery]. / Vergleichende Untersuchung zwischen arthroskopischen und offenen Meniskusoperationen.

In this paper we compared two groups of 80 patients each with meniscal tears. One group was treated by Arthrotomie and partial meniscectomie and the other group by an arthroscopic procedure also with partial meniscectomie. All patients were seen at a follow up between six and 18 months postoperatively. According to the Gaudernak scale we found in both groups 98% of very good and good results. The duration of hospitalisation and sickleave was reduced by 50% after the arthroscopic operation, which showed a significant difference.

[A rare combination injury in Alpine skiing]. / Seltene Kombinationsverletzung beim alpinen Schilauf.

This is a report on the incidence of associated osseos lesions in Achilles tendon ruptures. From 1967 to 1984 630 patients underwent treatment for closed Achilles tendon ruptures. In 49 cases (7.7%) associated osseos injuries were discovered. In 42 cases (6.6%) fractures of the malleolus medialis were found. Two patients with a rare combination (primarily treatment of osseos lesions, with delayed diagnosis of tendon rupture) deserve special attention. Concerning fractures of the lower leg with associated tendon rupture. Chronology and pattern of the injury are analyzed.

Greenstick fracture of the forearm with median nerve entrapment.

A case of bony median nerve entrapment is presented. Roentgenograms of a greenstick fracture without dislocation lured the examiner to ignore sensory deficit. Finally, delayed surgical exploration revealed complete nerve entrapment. A nerve graft was performed to reduce the functional loss.