[Will foam sclerotherapy and endovenous thermal ablation replace varicose vein stripping?]. / Können Schaumverödung und Thermoablation das chirurgische Venenstripping ersetzen?

Minimally invasive treatments of varicosis are increasingly establishing. Short and intermediate-term outcomes of endovenous treatments are satisfying: success rates are comparable with conventional surgery, whereas recovery is faster and complication rates are lower. Success rates are highest for endovenous laser ablation (EVLA). However, endovenous radiofrequency ablation (RFA) has advanced. Its short term outcomes are now comparable to EVLA, but with less side-effects. Ultrasound guided foam sclerotherapy (UGFS) replaced other forms of liquid sclerotherapy. In principle, this treatment can be combined with every other treatment for varicosis, but it loses its position as a monotherapy, due to poorer intermediate-term outcomes compared with EVLA and RFA. More prospective randomized controlled trials are needed in order to state an evidence based hierarchy of treatments for varicosis. With the minimally invasive treatments it is possible to treat patients on an outpatient basis. It will have to be assessed whether this will lead to higher cost-effectiveness.

[Treatment of complicated fracture of the distal radius with external fixator. Follow-up--complications--outcomes]. / Behandlung der komplizierten distalen Radiusfraktur mit dem Fixateur externe. Verläufe--Komplikationen--Ergebnisse.

The performance of the external fixation regarding severe fractures of the distal radius was evaluated by means of a very detailed retrospective study. Between 1989 and 1994 74 Patients with 76 fractures of the distal radius with a mean age of 69 years for female and 39 years for male patients were treated with the external fixator. 37% were open fractures. Using the ASIF classification, 21% were type A-fractures, 8% were type B-fractures and 71% were type C-fractures. In 44 cases the external fixator was used primarily, in 32 cases secondarily after failed conservative treatment. Additional procedures were partially necessary (K-wires, screws, bone grafts etc.). 32 complications had to be noted, the lesion of the superficial branch of the radial nerve being the most common (16%). After a mean follow up of 36 months 60 patients with 61 fractures could be evaluated clinically and radiologically. With the Sarmiento score as well as the Castaing score, 84% could be classified as very good or good, 16% as fair, no poor results were recorded. From this study we conclude that the primary treatment of complex fractures of the distal radius can be performed with external fixation along with the additional procedures necessary (K-wires etc.). Because of the reliable elimination of pain caused by the fracture, it forms a preventive measure against reflex sympathic dystrophy.

[Treatment principles in aseptic pseudarthrosis]. / Behandlungsprinzipien bei aseptischen Pseudarthrosen.

Aseptic pseudarthrosis may occur after all kinds of traumatology treatment. Following conservative treatment, incomplete immobilisation or an unattached bone fragment can be causal. After plate osteosynthesis the biomechanical principles are not efficient or the circulatory damage delays healing. There are two broad types of pseudarthrosis: vascular and nonvascular. The extent of vascularisation can be demonstrated by bone scintigraphy as well as X-ray. The treatment of vascular nonunions is very common. Mechanical stability is required, therefore a new osteosynthesis is desirable. Osteoporosis caused by inactivity and dislocation increases the rate of complications. Much more difficult problems are encountered in treatment of unreactive and avital pseudarthrosis, particularly in cases with a defect of bone substance. These defects can be treated with a segment transfer and a fibula-to-tibia operation. Extracorporal lithotripsy has been established as a new method in treatment of active and vascular nonunions. Former osteosynthesis is not a contraindication. Stability and immobilisation are necessary. Treatment in the low-frequency magnetic field shows no effect. Correct biomechanical and biological osteosynthesis with proper attention paid to location, quality of bone and asepsis can avoid the development of a pseudarthrosis.

[Recurrent hemarthrosis after cruciate ligament refixation by wire suture. A case report]. / Rezidivierende blutige Gelenkergüsse nach Kreuzbandrefixation durch Drahtnaht. Ein Fallbericht.

Recurrent haemarthros is described as consequence of cruciate ligament repair. The main cause of haemarthros is described after unisometric fixation of the ligaments which leads to the rupture of the synovia membrane. This is a case report of a young man, who suffered from recurrent haemarthros for several years although he has intensively examined by radiological and arthroscopical means. It was falsely presumed to be a muscular arthrophy. The cause, however, was found in a wire suture, which was used to fix the anterior cruciate ligament in the femoral bone. This suture was laying under the synovia within the ligament and there fore could be seen and taken away arthroscopically only after total synovialectomy.

[Can the results of cruciate ligament operations be arthrometrically evaluated? A comparison of subjective assessment, Lysholm score, clinical stability classification and measuring stability with the KT 1000 after complex knee injuries]. / Kann das Ergebnis nach Kreuzbandoperationen arthrometrisch erfasst werden? Ein Vergleich der subjektiven Einschätzung, des Lysholm-Scores, der klinischen Stabilitätseinstufung und der Stabilitätsmessung mit dem KT 1000 nach komplexen Kniebandverletzungen.

In a long-term follow-up of 88 patients with complex ligament knee injuries we examined 70 of these who were operated upon between 1.4. 1988 and 31.3. 1990. We specifically looked at local complications, clinical results and knee stability, using subjective and arthrometrical (KT-1000) results 1 or 2 years after operation. The only parameters with a good correlation with stability were the clinical examination (Lachman-test) and the results with the arthrometer in the anterior-posterior translation. Stability after ACL-reconstruction with augmentation with a polydiaxonaon (PDS) augmentation band was physiological (2 mm under 89 N anterior-posterior traction) in 77% of all knees but only in 57% under maximal anterior-posterior manual stress. Neither the subjective outcome of Lysholm-Score correlated with arthrometry and clinical examination.

[Use of ultrasound in acute and follow-up diagnosis of septic accident surgery]. / Einsatz der Sonographie zur Akut- und Verlaufsdiagnostik in der septischen Unfallchirurgie.

In 50 patients with infections of soft tissue, bone and joints, ultrasound examination was the first diagnostic procedure performed after clinical and X-ray examination. In 22 soft tissue infections the liquid portion of the infection area could be differentiated. Deep subfascial infections were detected in 7 cases before they were clinically apparent. The results of the ultrasound examination had an influence on the operation performed in 10 cases. In 18 patients with bone infections with abscesses the linkage of the fluid zone to the bone was demonstrable, and in 6 of these cases we saw extramedullary sequestrae as total reflecting parts. Empyema was diagnosed by ultrasound in association with clinical and laboratory parameters in 10 cases, including 3 in which clinical examination had not yet led to a firm suspicion. Real-time sonography influenced the operative treatment (time of intervention, approach) in 36% of all these cases was helpful in the diagnosis in all.