[Treatment of phalangeal fractures using the mini-hook plate. An alternative for surgical fixation of small phalangeal bone fragments?].

Background: Fixation of the small bony fragments of the phalanges is often difficult. In this study a clinical and radiological evaluation was carried out after operative treatment using the mini-hook plate.

Patients And Methods: Between 2003 and 2006 a total of 36 fractures were treated operatively using the mini-hook plate.

Fulminant unilateral pulmonary edema after insertion of a chest tube: a complication after a primary spontaneous pneumothorax.

Introduction: The insertion of a chest tube in cases of large pleural effusion or spontaneous pneumothorax is a common surgical procedure often performed by a physician in training under the supervision of a senior physician.

Case Presentation: The authors report the case of a 35-year-old man with a persistent, complete spontaneous pneumothorax of approximately 30 hours' duration. Within 90 minutes after insertion of a chest tube, he developed severe unilateral pulmonary edema and required mechanical ventilation.

[Biomechanical study of four palmar locking plates and one non-locking palmar plate for distal radius fractures: stiffness and load to failure tests in a cadaver model].

Five different palmar fixation plate designs were compared in a distal radial osteotomy cadaver model with regard to their biomechanical properties. A metaphyseal osteotomy gap of 1 cm was performed and the osteosynthesis was plated according to the manufacturer's instructions. Axial load was applied to the construct by a pneumatic material testing machine.

[The distally based sural neurocutaneous island flap for coverage of soft-tissue defects on the distal lower leg, ankle and heel].

Objective: Stable coverage of soft-tissue defects in the critical regions of the distal lower leg, ankle and heel by avoidance of a microsurgically transplanted free flap.

Indications: Soft-tissue defects < or = 10 cm in diameter--either by trauma or complications (skin necrosis, infection)--on the distal lower leg, ankle or heel with exposed osseous, tendinous or articular structures including high-risk patients (diabetes mellitus type 1/2 and/or arterial vascular disease including stage IIb, not capable of improvement).

Contraindications: Relative: diameter of defect > 10 cm.

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.

Mean maternal second-trimester hemoglobin concentration and outcome of pregnancy: a population-based study.

Both anemia and the lack of physiological maternal plasma volume expansion during the second trimester are associated with higher maternal morbidity and poor fetal outcome. Mean hemoglobin levels between the 14th and 30th gestational weeks were calculated in 4985 consecutive pregnant women and were correlated with outcome data of pregnancy. It was found that 9.

Ultrasound-guided spinal fracture repositioning, ligamentotaxis, and remodeling after thoracolumbar burst fractures.

Study Design: Computed tomography aided evaluation of spinal decompression by ultrasound-guided spinal fracture repositioning, ligamentotaxis, and remodeling after thoracolumbar burst fractures.

Objectives: To determine the necessity of spinal canal widening by ultrasound-guided fracture repositioning for fractures with and without neurologic deficit.

Summary Of Background Data: Ultrasound-guided spinal fracture repositioning is an alternative new approach.

Locking plates for corrective osteotomy of malunited dorsally tilted distal radial fractures: a biomechanical study.

The purpose of the study was to compare the biomechanical properties of five different palmar fixation plate designs in a distal radius osteotomy cadaver model. A 1cm metaphyseal osteotomy gap was made to simulate a corrective osteotomy and the osteotomy plated. Axial load was applied to the distal end of each construct by a material testing machine under control of a motion analysis video system.

The phenomenon and efficiency of ligamentotaxis after dorsal stabilization of thoracolumbar burst fractures.

Thirty-six consecutive patients with burst fractures of the thoracolumbar spine and with a fractured posterior vertebral surface dislocated into the spinal canal without neurological symptoms were treated with the AO internal fixator. Computed tomography-aided planimetry of the spinal canal was undertaken preoperatively and within 1 week postoperatively to elucidate the effect of kyphosis correction and distraction on spinal canal widening (ligamentotaxis). The stenosis of the spinal canal area (SCA) was reduced from 29% preoperatively to 19% postoperatively (+10%) of the estimated original area, and the stenosis of the mid-sagittal diameter (MSD) reduced from 31 to 23% (+8%).

["Progressive" hypothenar hammer syndrome Indication for operative treatment].

Hypothenar hammer syndrome (HHS) is ischemia of the distal ulnar artery caused by injury to the ulnar part of the palmar arch. This disease often involves workers who frequently use the hypothenar part of the hand as a hammer. The aneurysmatic form of HHS represents an indication for operative treatment; the thrombotic form is treated mainly conservatively.

Friction of ceramic and metal hip hemi-endoprostheses against cadaveric acetabula.

Introduction: Studies of hip arthroplasty have dealt mainly with total endoprosthesis, while tribology measurement values of hemi-endoprosthetic implants are rare. The small amount of experimental tribological data concerning materials of hemi-endoprosthetic implants in the form of pendulum trials, animal experiments, in vivo measurements on human hip joints and pin on disc studies report friction coefficients between 0.014 and 0.

[Monteggia injuries in adults: Critical analysis of injury pattern, management, and results].

Background: Complications, revision surgery, and unsatisfactory functional results after operative management of Monteggia fractures are frequent. Moreover, hardly any studies exist that deal exclusively with the therapeutic concept for adults.

Patients And Methods: Between January 1988 and December 2001, 68 patients with Monteggia fractures or equivalent injury were surgically treated.

[Intramedullary osteosynthesis of the ulna in revision surgery].

The exact and adequate management of diaphyesal fractures of the forearm is necessary to ensure forearm motion. Unsatisfactory treatment can lead to loss of function and disability of forearm and hand movement, resulting in severe patient morbidity. Since the rotational and angulatory stresses at the fracture site are the superior factors which influence the outcome of the forearm fracture healing after surgical treatment, the implants must fulfill some general prerequisites including high biomechanical stability, less invasive surgical approach and adequate biological features.

Limb trauma with arterial injury: long-term performance of venous interposition grafts.

Background: In contrast to arterial occlusive disease, data on long-term outcomes after vein grafts in limb trauma with arterial injury are sparse.

Patients: From 1991 through 2001, 22 trauma victims received 23 interposition vein grafts performed by an interdisciplinary team of trauma and vascular surgeons. Indications included both blunt and penetrating injuries with critical limb ischemia in the majority of cases.

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.

[3D CT of fractures: comparison of volume and surface reconstruction].

Purpose: The comparison of volume rendering (VR) and surface rendering (SSD) for demonstrating fractures from spiral-CT data.

Materials And Methods: Standardized VR and SSD projections were produced from 50 spiral CT scans of 50 consecutive patients with fractures. Appropriate multiplanar reformattings (MPR) were used as the standard.

[Efficacy of ultrasound controlled direct reposition of fragments of the posterior vertebral body facet].

To calculate canal compromise and decrease of midsagittal diameter caused by retropulsion of fragments into the spinal canal we analyzed the pre- and postoperative computed tomographies of 32 patients with unstable thoracolumbar burst fractures treated by USS (universal spine system). Our intention was to examine the efficiency of ultrasound guided repositioning of the dispaced fragments which was performed in all 32 cases. We found a clear postoperative enlargement of canal area (ASP preoperatively 55%, postop.

[Complications of endoscopic retinaculum dissection].

Reviewing the literature on endoscopic carpal tunnel release (biportal Chow-technique and uniportal Agee-technique), we found 31 different intra- and postoperative complications. Of these, 14 affected nerve structures, four vessel structures, two tendon structures, two bony structures, and nine surrounding tissues. The most common complications were analyzed taking anatomical and pathological variations of the carpal tunnel into consideration.

[Magnetic resonance tomography examination of thoracolumbar spinal fractures after fixateur interne stabilization].

To analyse the possible injuries of vertebral segments, especially the disc, after unstable thoracolumbar fractures stabilised with AO internal fixator, we performed magnetic resonance imaging (MRI) of the traumatised region after implant removal. There were two aspects of disc degeneration (DD):(1) biochemical changes and (2) structural damage. MRI detects biochemical processes as one aspect of DD that is often small even in the presence of greater structural damage of the nucleus pulposus caused by fracture.

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.

[Radiation burden to the hands of surgeons in intramedullary nailing].

During 41 procedures of intramedullary nailing of femoral and tibial fractures the primary surgeon and the first assistant wore ring dosimeters on their dominant index fingers. While the average fluoroscopy time per procedure was 4.6 min the average dose of radiation to the dominant hand of the primary surgeon was 1.

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.

[Color-coded duplex ultrasound as a screening method in trauma surgery].

Deep vein thrombosis with consecutive pulmonary embolism is one of the most important complications for trauma patients. At the University Hospital of Mainz, Department of Traumatology, colour duplex ultrasound is used as screening method in trauma patients. Fractures of thoracic and lumbal spinal bones, pelvis, hip and lower extremities, endoprosthesis of hip and knee joints and longer immobilisation are considered as special risk for the genesis of deep vein thrombosis.

[The "inserted" condylar plate].

Twelve extensive segmental and comminuted fractures of the femur affecting the metaphyseal areas (7 times proximal, 5 times distal) and the diaphysis were treated with extremely long condylar plates (16 to 20 holes). The condylar plates were inserted via a proximal and a distal incision leaving the Musculus vastus lateralis intact at the fracture site in all cases. Following standard preparation of the blade position using the seating chisel, the condylar plate was inserted behind the musculus vastus lateralis with the blade pointing towards the surgeon.

[The effect of bone marrow embolization on the choice of procedure in the stabilization of femoral fractures].

Because of an extended venous drainage system, especially in the supracondylar area, a pressure increase in the femoral cavity results in embolization of the contents of the bone marrow cavity. Bone marrow embolization alone is mostly not apparent clinically but together with cofactors it may result in severe pulmonary damage and occasionally even in death. Cofactors are volume deficit, shock, thoracic and polytrauma and preexisting pulmonary disease.