[Trauma hospital. Knee arthroplasty as primary therapy for proximal tibial fracture]. / Unfallkrankenhaus. Knieendoprothese als Ersttherapie bei proximaler Tibiafraktur.

Ten patients aged 55-85 years with a tibial head fracture AO B3 or C3 were treated primarily by implantation of an endoprosthesis. There were one unilateral, three superficial, and six revision-type prostheses. Follow-up was 6 months to 3 years; two patients were lost to follow-up. There were no intra- or postoperative complications except one deep infection which could be cured by repeated arthroscopic lavage. At last follow-up all eight patients were completely or almost pain free; the extension deficit was less than 10 degrees , and flexion was 100 degrees or more. Primary endoprosthetic replacement of the knee joint is a valuable procedure for the treatment of complex tibial head fractures in elderly patients.

Clinical outcome of salmon calcitonin nasal spray treatment in postmenopausal women after total hip arthroplasty.

OBJECTIVE: The increasing rate of hip fractures is giving rise to a number of socio-economic problems for the aging community. In addition to being unable to resume their previous living habits, many patients fail to achieve full functional recovery after the fractures. Total hip arthroplasty (THA) is a successful operation for the majority of patients with all forms of hip fractures, being performed increasingly often throughout the world. Revision rates for THA range up to 20% per year. Aseptic loosening is the reason for 75% of the revisions. An additional problem post-THA is the rate of heterotopic soft tissue calcification after THA, resulting in severely impaired function, pain, and a reduced range of hip movement. SUBJECTS: In an open study, 37 women who had undergone cementless THA after accidental hip fractures were treated twice daily with 200 IU of salmon calcitonin nasal spray for 12 months. Simultaneously the patients received one bag of 1,000 mg calcium plus 880 IU vitamin D daily throughout the treatment period of 1 year. A parallel group of 38 women with a similar clinical status in terms of hip fractures and cementless THA were treated with only one bag of 1,000 mg calcium plus 880 IU vitamin D daily through the treatment period. RESULTS: The results of this 12-month clinical trial show that 200 IU of salmon calcitonin nasal spray per day significantly improves the clinical outcome of postmenopausal elderly women following THA. Treatment with a salmon calcitonin nasal spray significantly reduces bone turnover, loss of bone density, and pain. The functional status of the patients was improved and the risk of falling reduced by rehabilitation during the observation period of 12 months. Additionally, calcitonin promoted the repair of hip fractures and was associated with a significantly lesser rate of refractures as well as periprosthetic ossifications. CONCLUSION: The increasing revision rate for THA during the first year and the patient's problem of resuming their previous living habits are the main foci of our study. Calcitonin nasal spray seems to cause few side effects. The additive treatment appears to improve the clinical outcome of THA in elderly postmenopausal women.

[The course of intracranial pressure during respirator weaning after severe craniocerebral trauma]. / Verlauf des intrakraniellen Drucks während der Entwöhnung vom Respirator nach schwerem Schdel-Hirn-Trauma.

To analyze the characteristics of hemodynamic parameters and cerebral dynamics, the courses of intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial blood pressure (MAP) and PaCO2 were analyzed retrospectively in 29 patients with severe head injury, comparing periods before and after the ventilatory mode was changed from controlled mechanical ventilation to spontaneous breathing with continuous positive airway pressure. Measurements were done before and after changing of the ventilation. Patients were allocated either to group I (n = 22, ICP remained stable: 18 +/- 2 mm Hg in both periods of observation) or group II (n = 7, ICP increased from 25 +/- 3 mm Hg to 33 +/- 4 mm Hg, P < 0.05). While changes of MAP did not reach significant levels in either group, concomitant changes in CCP appeared in group II (67 +/- 2 mm Hg to 60 +/- 2 mm Hg). Based on the observation of relatively high incidence of ICP increases and deterioration of CPP during weaning from ventilator, it is recommended that continuous ICP monitoring should be continued.

Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures.

One hundred forty-two patients with malleolar fractures were followed up for an average of 5.7 years postoperatively. In 80 cases (56.4%) we found no lesion of the distal articular surface of the tibia; 62 patients (43.6%) had a fracture of the posterior tibial margin. Both groups were closely matched with regard to fractures of the lateral and medial malleolus. The long-term results were significantly poorer when a fracture of the posterior tibial margin was additionally present, even in cases with a small marginal fragment of the lip of the tibia. Further, we found a clear relationship between the articular involvement and the incidence of post-traumatic osteoarthrosis in cases with no additional osteosynthesis of the fragment. In cases of larger fragments, the long-term results after anatomic reduction and additional osteosynthesis were on the whole far better than in cases treated conservatively.

[Treatment of fresh subcutaneous flexor tendon rupture of the distal joint of long fingers with temporary bone wire arthrodesis]. / Zur Behandlung des frischen subkutanen Strecksehnenausrisses im Endgelenk der Langfinger mit temporärer Bohrdraht-Arthrodese.

Drop-finger at the distal joint or mallet-finger from injury occurs because of the extensor apparatus is so much weaker than the flexor tendon that it breaks under strain. We report on 100 cases treated by internal splinting with longitudinal applied Kirschner wire in the distal and middle phalanx of the finger. It affords an absolute immobilisation of the distal interphalangeal joint in slight hyperextension with relaxation of the extensor apparatus. The wire was removed after six weeks. The results evaluated in 76 patients by follow-up four to 84 months were classified as excellent in 86.8% (full range of motion), good in 11.9% (loss of motion 5 to 15 degrees), and poor in 1.3% (loss of motion more than 15 degrees). The excellent and good results emphasize that internal splinting in ruptures of the extensor apparatus near the distal interphalangeal joint.

Injuries of the lateral ligaments of the ankle joint. Operative treatment and long-term results.

Between 1980 and 1984, 268 patients with recent ankle ligament ruptures were treated with primary surgical repair at the 2nd Department of Trauma Surgery, University of Vienna. The decision for immediate operative treatment was based on clinical findings as well as on a positive stress roentgenogram. Ligament ruptures were diagnosed if the talar tilt on the injured side exceeded that on the uninjured side by 5 degrees or more or if the ventral subluxability of the talus was more than 5 mm compared with the uninjured side. One hundred twenty-two patients were followed up for 2-6 years after operation; follow-up included physical examination as well as standardized and stress roentgenograms. Good results were obtained in 80% of cases, moderate results in 17%, and poor results in 3%. All of the poor results were due to persistent radiological instability and/or arthrotic joint degeneration. The incidence of infection was 1.5%.

[Experiences using the rotation femur head prosthesis in the treatment of medial femoral neck fractures in geriatric patients]. / Erfahrungen mit der Rotationsfemurkopfprothese bei der Behandlung medialer Schenkelhalsbrüche geriatrischer Patienten.

We report upon 167 fractures of the medial femoral neck (166 patients aged 82 years on average) that were treated by hemialloarthroplasty (trunnion hip prosthesis Allo-Pro). 94 patients were followed-up from three to 53 months (average 18 months) postoperatively. 67 patients regained their full physical activity. This operative technique is indicated in fractures with high risk of femoral head necrosis and in patients with reduced physical conditions. We see the advantage of hemialloarthroplasty in the relatively small operative trauma and the possibility of early mobilization.

[Effect of high-frequency ventilation on intracranial pressure]. / Auswirkungen hochfrequenter Beatmungstechniken auf den Verlauf der intrakraniellen Druckkurve.

The influence of respiratory frequency, tidal volume, inspiratory flow and ratio of inspiratory/expiratory time on ventilator-related intracranial pressure (ICP) fluctuations was studied in six patients with severe brain trauma. ICP fluctuations were found to be markedly reduced at frequencies of 20/min and usually eliminated at 30/min. We found an exponential correlation between ICP fluctuations and respiratory frequency, but there was no correlation between tidal volume and ICP. Central venous pressure amplitudes were found to be in linear correlation with respiratory frequency and tidal volumes as well. The amplitude of respiratory ICP fluctuations correlates with the length of expiratory time. Our findings demonstrate that artificial ventilation without ventilator-related fluctuations in ICP ("brain-protective" ventilation) may be performed by conventional volume-constant, time-cycled ventilators. To assess the therapeutic relevance of eliminating respirator-related fluctuations of the ICP course in brain-injured patients, we suggest that frequencies of 25-30/min and tidal volumes of 6-9 ml/kg body weight should be used.

[Special artificial respiration procedures and intracranial pressure. Animal experiment studies, development and use of a new pressure measuring technic, clinical aspects]. / Spezielle Beatmungsverfahren und intrakranieller Druck. Tierexperimentelle Untersuchungen, Entwicklung und Anwendung eines neuen Druckmessprinzips, Klinik.

We investigated the influence of Forced Diffusion Ventilation (FDV), a special form of High Frequency Ventilation (HFV), on elevated intracranial pressure (ICP) in 5 dogs. Elevation of ICP was standardized by inflation of an epidural balloon. A typical finding with FDV is a reduced intrapleural pressure and therefore one could expect a better cerebrovenous drainage influencing ICP. Nevertheless, we found no changes in mean ICP under conditions of FDV compared with IPPV. Respirator-synchronous fluctuations of ICP, cisternal cerebrospinal fluid pressure and intrapleural pressure were drastically reduced with FDV. This phenomenon has been already reported by other groups as a typical effect of HFV with rates of 100/min. One can speculate, that this immediate impact of HFV on ICP-curves might be of some advantage in patients with critically reduced intracranial compliance requiring long-term artificial ventilation, because peaks and amplitudes of ICP are reduced. Our clinical experience with High Frequency Pulsation (HFP) includes 11 patients with severe brain trauma. In clinical routine this method of HFV is more facile to applicate than FDV, because there is no need of a special endotracheal tube and sufficient CO2-elimination is not strongly dependent on precise position of the tube. But HFP, as FDV, includes all advantages of respiratory systems, that are open against atmosphere (coughing and simultaneous breathing, without drastically increasing airway pressure, suction during respiration, etc.). However, we could find no special advantages or disadvantages in ICP-course during long-term application of HFP (up to 10 days). Because application of HFV is dependent on special technical equipment, we investigated in 6 patients the influence of respiratory frequency, tidal volume and inspiratory flow on ICP-fluctuations using conventional ventilators. ICP was recorded by a new, self constructed pneumatic epidural pressure sensor. Ventilator-related ICP-fluctuations were found to be markedly reduced at frequencies of 20/min and usually eliminated at 30/min. We found an exponential correlation between ICP-fluctuations and respiratory frequency and there was no correlation between tidal volume and ICP. Central venous pressure amplitudes were found to be in linear correlation with respiratory frequency and tidal volumes as well. The amplitude of respiratory ICP-fluctuations seems to be more dependent on duration of expiratory time. As our findings demonstrate, artificial ventilation without entilator-related fluctuations in ICP ("brain-protective" ventilation) may be performed by conventional volume-constant, time-cycled ventilators.(ABSTRACT TRUNCATED AT 400 WORDS)

[Effect of arm splinting on the duration and possibility of monitoring invasive long-term pressure determination of the radial artery]. / Einfluss der Armschienung auf Verweildauer und Monitierbarkeit bei blutiger arterieller Langzeitdruckmessung über die A. radialis.

A special splint technique, which can improve continuous intraarterial blood pressure monitoring via the a. radialis is reported. This method could be applied successfully in 41 patients of the ICU up to 27 days. Cannulating the contralateral side because of catheter's dysfunction was necessary only in 6 patients. These observations could be seen in contrast to our results, using a conventional splint system, applied in 12 patients for comparison (maximal duration of catheter's placement: 9 days). Our experiences, using this special splint method of arm fixation, lead to the recommendation to use our method routinely in long-term monitored patients, with respect to a longer duration of catheter's intravasal placement, the possibility of undisturbed monitoring and a simple clinical handling.

[Haemarthros of the upper ankle joint (author's transl)]. / Hämarthros des oberen Sprunggelenkes.

34 patients with isolated, non-dislocated fractures of the medial malleolus and consecutive haemarthros of the upper ankle joint were followed up at an average of 8 years after the trauma. Special attention was given to arthrotic deformities and complaints. The results of this study seem to point to the conclusion that postraumatic haemarthros itself is of no special importance in the development of arthrotic changes of the upper ankle joint in man. This was judged from the pathophysiological reactions of articular cartilage due to haemarthros as shown in animal experiments.

[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.

Incorporation of [U-14 C]glucose into metabolites of brain, liver and blood of rats pretreated with reserpine or phenothiazines.

Parkinsonism was induced in rats by using phenothiazines (Butyrylperazin and Thioproperazin). (P-group), or reserpine, (R-group). [U-14 C)D-glucose was administered when the symptoms of Parkinsonism had become fully developed. Concentrations and radioactivities of different metabolites were studied in brain, liver and blood serum. 1. Both types of treatments resulted in a decrease in the synthesis of amino acids from [14C]glucose in the brain. The concentrations of amino acids and the glycogen remained uneffected. Phenothiazines enhanced the conversion of lipids, while reserpine increased their concentration. 2. Reduced de novo synthesis of amino acids was recorded in the liver. Phenothiazines resulted in the storage of glycogen and lipids; reserpine resulted in the storage of lipids and enhanced the conversion of glycogen. 3. Both treatments caused a fall in the amino acid concentration of the blood serum. A rise in the specific radioactivity of blood amino acids was observed in the P-group, while a decrease in specific radioactivity was observed in the R-group. A hyperglycemia was induced in the R-group with reduced specific radioactivity of glucose in both P-and R-groups. A reduction in lipid concentration of blood serum was achieved with an increased specific radioactivity in P-group and decreased radioactivity in R-group. 4. The changes in amino acids common to both treatments are also observed in human Parkinsonism.

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.