[The treatment of severe head-brain injuries in Austria] . / Die Behandlung des schweren Schädel-Hirntraumas in Osterreich.

INTRODUCTION: We performed this study in order to assess epidemiology and current practice of treatment of severe traumatic brain injury in Austria. Our survey followed the methods of a study published by J. Ghajar et al in the USA in 1995 and we compared the results to the Brain Trauma Foundation's "Guidelines For The Management Of Severe Head Injury". METHODS: The collected data represent answers to telephone interviews of 60 surgical intensive care units. We were able to evaluate data from all departments which treat severe brain traumas (Glasgow Coma Scale < or = 8) in Austria. RESULTS: At the time the treatment modalities of severe head injuries are not homogeneous and there are also big interdisciplinary management differences (trauma surgeons versus neurosurgeons). CONCLUSIONS: Results showed that there is a need for a brain trauma databank in Austria. We also recommend formation of an interdisciplinary brain trauma working group in order to control whether guidelines and standardized therapeutic modalities are being followed.

Electromyogram-controlled functional electrical stimulation for treatment of the paralyzed upper extremity.

Spinal cord lesions at level C5 to C6 lead to loss of hand functions and lesions at C4 to additional deficits of arm functionality. The presented dual channel surface stimulator with dual channel electromyogram (EMG) measurement was developed to investigate control strategies for an EMG-controlled implantable stimulation system and serves in addition as a therapy device for patients with partial innervation but weak muscle force. Four different control strategies for stimulation amplitude are available. The amplitude can be preset manually or can follow the preprocessed EMG signals proportionally. The shoulder control program allows proportional control of both stimulation channels with one EMG channel while the second EMG channel serves as the channel selector. Finally, a special feedback training program triggers a stimulation burst when EMG activity is detected. During a 2 year patient study, 18 patients from 2 hospitals and 1 rehabilitation center performed the feedback training. Almost all patients obtained an improvement of functionality. Apart from muscle strengthening, the feedback effect led to an improvement of proprioception and supported relearning of motions. For the documentation of the training status, functional muscle test (British Medical Research Council) and measurements of power, angle, torque, muscle fatigue, and EMG were performed. Obviously, EMG triggered stimulation provides several advantages compared to conventional passive electrical stimulation.

[The value of arthroscopy in the management of anteromedial lesions of the knee joint. A therapy concept]. / Die Bedeutung der Arthroskopie bei der Versorgung der anteromedialen Läsion des Kniegelenkes. Ein Therapiekonzept.

Based on the clinical findings from twenty-seven patients over a mean follow-up period of 27 months, a therapeutic management plan for anteromedial lesions of the knee is presented. This is based both on the usual instability tests in narcosis and on accurate arthroscopic evaluation of the lesion to the medial ligamentous apparatus. Additional open reconstruction of the posteromedial ligamentous apparatus was only performed in cases of arthroscopic lesions Type III after arthroscopic management of all internal knee-joint injuries. The average period of rehabilitation was 10 weeks in the case of Type I lesions and 16 weeks in the case of Type III lesions. This compares with results following conservative treatment. At follow-up, 66% of the knee-joints were found to be stable in the Lachman test, and 81.5% were stable in the abduction stress test. Excellent and good results were achieved in 96.2% of cases according to the Lysholm scoring scale. The advantages of arthroscopy lie not only in the possibility of treating all internal knee-joint injuries including the deeper layers of the medial ligamentous apparatus, but also in protecting the vastus medialis, which is of particular importance for the prognosis of anteromedial lesions.

[Results after surgical stabilization of the ruptured shoulder joint. Combination procedure versus Bosworth screw]. / Ergebnisse nach operativer Stabilisierung des zerrissenen Schultergelenkes. Kombinationsverfahren versus Bosworth-Schraube.

From 1979 to 1989, 46 patients were operated on for luxation of the acromioclavicular joint (Tossy III) in the department of trauma surgery of the Krankenhaus der Barmherzigen Brüder, Eisenstadt. During the first few years, a combination of traction strapping and Boswoth screws was applied (22 patients) Owing to the high incidence of joint trauma and resulting functional deficit, this procedure was abandoned in favour of fixation with the Bosworth screw alone, combined with transosseous refixation of the joint capsule. The incidence of postoperative complications was approximately equal for both procedures (a total of 3 infections which healed completely, 7 secondary dislocations on removal of the screws, 5 cases of broken or migratory screws). Radiological and clinical follow-up examinations were performed on 36 out of 46 patients up to 93 months postoperatively. In 14 cases, the radiological examination revealed moderate to pronounced signs of arthrosis; the combined procedure was followed by a significantly higher rate of arthrosis. A significant correlation was also found between residual displacement and the occurrence of arthrosis. In cases where only Bosworth screws were used, more joint diastases occurred. In the opinion of the authors, unsatisfactory results are likely to be due to faulty operational technique rather than to the method itself. In general, better reductional results were achieved with the combined method. With reference to the restoration of joint function, however, significantly better results were achieved with exclusively extra-articular stabilization.