[Post-traumatic lesion of the distal radioulnar joint with disordered forearm pronation]. / Posttraumatische Schädigung des distalen Radioulnar-gelenkes mit Störung der Unterarmumwendbewegung.

Within a period of 14 years in 27 cases operative correction of a traumatic lesion of the distal radioulnar joint has been performed at the University Clinic of Giessen. The follow-up of our results is to be confined to the last ten cases; all efforts to evaluate the outcome of 17 joints having been operated on previously unfortunately have proved to be unfeasible. Different types of corrective operative procedures have been accomplished. Improvement of wrist function, particularly of pronation and supination, was obtained in almost every case.

[Autologous blood-antibiotic filling as effective therapy of chronic osteomyelitis]. / Die Eigenblut-Antibiotika-Plombe als wirksame Therapie der chronischen Osteomyelitis.

A control of osteomyelitis by parenteral administration of antibiotic drugs is not possible due to sequestration, thrombosis of the peripheral vessels, and encapsulation of the osseous focuses. The autoblood-antibiotic plombage was indicated in 1951 by Winter. The principle used for this method is the concentration of one or more antibiotic drugs in an autogenic carrier releasing the drugs which then exert their effect directly at the site of the disease. In the experimentation on animals, the streptomycin level in the peripheral blood decreases only after 130 hours to the inhibiting threshold value of 0.008 g/ml. The autoblood-antibiotic filling becomes a connective tissue filling and, about seven weeks later, a bone filling. There are three conditions for a therapeutic success of the antibiotic plombage. 1. It must be only a limited, unilocalized, not too extended bone process. 2. large débridement and sequestrotomy, and 3. the bone must be provided with an own absolute stability. 74 out of 112 patients treated with an autoblood-antibiotic plombage were immediately free from symptoms. Two thirds of these patients showed a superficial recovery.

[Continuity resections of long tubular bones and subsequent bone reconstruction]. / Kontinuitätsresektionen langer Röhrenknochen und späterer knöcherner Wiederaufbau.

The osseous restitution of extended deficiency pseudarthroses is possible by means of modern osteosynthesis methods which exactly immobilize the bone. However, numerous operations are required in order to prevent infections and to reconstruct the osseous stability by subsequent bone chip grafts. The treatment may take three to five years, and relapse and even failure will occur frequently. This aspects have to be discussed with the patient before beginning such a treatment, and there must not be any doubt that the patient really desires to be treated in this way.

[Measurements of blood supply of freely transplanted rib and iliac crest grafts by the tracer microsphere method]. / Durchblutungsmessungen an frei transplantierten Rippen- und Beckenkammspänen mit der Tracer-microspheres-Methode.

The actual blood perfusion of bone grafts in the lapse of time of their implantation is demonstrable by the tracer microsphere-method. The transplanted rib bone graft turns out to be almost equal to the cortico-spongiose pelvis bone graft concerning the blood perfusion. The long distance bridging rib bone graft shows the blood perfusion of the starting point after six weeks.

[Considerations on the time of surgery of femoral fractures]. / Gedanken zum Zeitpunkt der Operation bei Frakturen des Oberschenkelknochens.

As shown by a study elaborated in 1980 by the A.O. (Working Association for Osteosynthesis) which was based on the data of 1127 patients, the number of general complications occuring during the primary treatment of fractures of the femur had increased by 13%. However, this study also comprised a great number of polytraumatically injured persons possessing other indications for surgery than patients with monosseous fractures of the femur shaft. So all monosseous fractures of the shaft were compiled with the aid of the A.O. computer in Bern, and 1257 cases were received. It is clearly demonstrated by evaluating these cases that a primary treatment of fractures of the femur has a significantly better effect than a delayed treatment. The number of cardiac complications increases with the time interval passing between injury and treatment. The same effect was not statistically proved for pulmonary complications; on the contrary some pulmonary complications occured during primary treatment in young patients, i.e. in a group of patients where this is expected least of all. For the future, the circulatory parameters of these patients must be estimated with special accuracy. Fatalities only occurred in the group of the oldest patients; the number of deaths increased significantly with the time interval after the injury. The differences between the present study and the preceding. A.O. study of 1980 are explained by the relatively great number of polytraumatically injured persons with fractures of the femur included in the first study. However, no satisfactory explanation does exist for the deaths occurred in 1972 at our own hospital, mentioned at the beginning of this report.

[Talus injuries]. / Talusverletzungen.

Due to function and anatomy the talus plays a special part among the tarsal bones. The extended joint surfaces cause a high rate of arthrosis in fractures, the difficult blood supply leads very often to a disturbance of the supply of the talus in the case of vulneration. Fractures are divided in central and peripheral forms which could be caused either by simple or compound fracture mechanism. The computed tomography offers precious informations in the diagnosis of talus vulnerations. Besides the conservative therapy of peripheral fractures there is the operative treatment of central fracture forms. Infection, arthrosis and necrosis of the talus are to be mentioned especially as postoperative complications.

[Indications and results in shortening osteotomy of the ulna]. / Indikation und Ergebnisse der Verkürzungsosteotomie der Ulna.

A relatively or absolutely too long ulna leads always to pain in the wrist, so that a compensation in length of both forearmbones is achieved by shortening osteotomy. The gradual ulna shortening osteotomy, the stylectomy and the resection of the caput ulnae with or without radius transposition osteotomy are available as shortening operation. In 17 patients of the Giessener Unfallchirurgischen Klinik we performed in 14 cases a shortening osteotomy of the ulna and in 3 cases a resection of the caput ulnae. The shortening osteotomy lead in all cases to a reduction of complaints and to an improvement of the mobility of the wrist. Due to frequent arthropathy the resection of the caput ulnae should be taken more often into consideration in older people.

[Surgical indications and choice of procedure in distal radius fractures--wire, plates, external fixation]. / Operationsindikation und Verfahrenswahl beim distalen Radiusbruch--Draht, Platten, Fixateur externe.

The treatment of the typical fracture of the radius is predominantly conservative. Unstable fractures, bending fractures and open fractures will receive operative treatment. Hereby Kirschner wires, blade plates and screws are applied for osteosynthesis. Heavy comminuted fractures were stabilized, besides by minimal osteosynthesis, by a mini-external fixation unit. The results of operative treatment in the Unfallchirurgische Klinik Giessen were in 50% excellent and good, in 38% satisfactory and in 12% bad. The main complications were disturbances of sensibility in the area of the superficial branch of the radial nerve.

[The upper arm plaster cast]. / Der Oberarmbewegungsgips.

In order to treat the scaphoid bone fracture, the most frequent of all carpal fractures, a long immobilization is necessary. This can only be guaranteed by an upper arm plaster cast eliminating pronation and supination of the forearm. We use a modified plaster cast of Verdan, namely a hinge-type plaster cast applied to the upper arm, allowing flexion and extension but blocking pronation and supination. The indications are: - conservative treatment of scaphoid bone fractures - postoperative retention of scaphoid bone fractures operated upon - insecure osteosynthesis of the forearm shaft - postoperative elbow luxation We apply the Baycast bandage and hinge splints without stop made of V2A steel. Until now, four patients have been treated successfully with the hinge-type plaster cast.

[Changes of bone-perfusion in osteosynthesis of the femur with a marrow-nail (author's transl)]. / Veränderungen der Knochendurchblutung nach Femurmarknagelosteosynthesen beim Schäferhund.

The perfusion of the bone in the hind leg after osteosynthesis (nailing of the bone-marrow) was studied. In 11 shepherd dogs (bastards) an osteotomy of the femur was done; it was treated with a marrow-nail without boring the marrow-cavity. With the "tracer-microsphere"-method the perfusion of femur, tibia and talus of both hind legs was measured. Measurements were performed before and after surgery, in 10 dogs 2 weeks and in 8 dogs 6 weeks after surgery. Immediately after the operation the perfusion was reduced considerably in all the examined bones of the operated leg. Two weeks later the perfusion was increased in all bones of both hind limbs. In the cancellous bone of the femur the perfusion reached the original preoperative values after 6 weeks; in cortical bone a further increase of the perfusion was noted. This increase was most marked in the cortical bone of the operated femur; it was less in the cortical bone of the other bones.