ABSTRACT
Four children between the age of 10 and 13 years with distal radius fractures healed with dorsal angulation presented to us in our out-patient department. All had been treated conservatively with an upper-arm cast, all fractures had healed with an average dorsal angulation of 10 degrees. Despite this dorsal angulation, the patients were pain free. Subsequent minor injury resulting in pain to the wrist was now the reason for their presentation. On examination we found a spontaneous palmar dislocation of the ulnar head during supination. This proved to be resistant to conservative therapy. In all cases corrective osteotomy of the radius at the level of angulation was performed. Redislocation of the ulnar head was prevented by this method in all cases.
Subject(s)
Fractures, Malunited/complications , Joint Dislocations/etiology , Joint Instability/etiology , Radius Fractures/complications , Ulna , Wrist Joint , Adolescent , Age Factors , Child , Female , Follow-Up Studies , Humans , Joint Dislocations/diagnostic imaging , Joint Dislocations/surgery , Male , Osteotomy , Radiography , Supination , Time Factors , Wrist Joint/diagnostic imagingABSTRACT
Ligamentous and osseous injuries of the cervical spine during growth are extremely rare and therapeutic principles for such lesions are ill-defined. In order to help solve some diagnostic and therapeutic problems a retrospective study of 30 children was carried out. There were 5 discoligamentous injuries, 5 fractures of the atlas, 1 fracture of the arcus C2, 8 fractures of the odontoid, and 11 vertebral body compression fractures. The injuries were caused by motor vehicle accident in 9, by diving into shallow water in 7, by falling from a height in 7, by a sports accident in 6, and by a direct trauma in 1 patient. Four children died, three of them due to concomitant brain injury. Two patients suffered permanent neurologic disability due to spinal cord trauma. Five patients underwent an operation. Conservative therapy of flexion-compression fractures of the vertebral bodies caused kyphotic deformity. Ventral interbody fusion in two patients had excellent long-term results. All odontoid fractures were treated by applying a plaster cast and healed promptly. Diagnostic problems were mainly caused by the hypermobility of the upper cervical spine.
Subject(s)
Cervical Vertebrae/injuries , Joint Dislocations/surgery , Spinal Fractures/surgery , Adolescent , Austria , Brain Injuries/diagnostic imaging , Brain Injuries/mortality , Brain Injuries/surgery , Cause of Death , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Joint Dislocations/diagnostic imaging , Joint Dislocations/mortality , Male , Radiography , Retrospective Studies , Spinal Fractures/diagnostic imaging , Spinal Fractures/mortality , Survival RateABSTRACT
The Spiegelberg device is based on air-filled balloon system and was designed for epidural ICP monitoring. Zero adjustment is done automatically with the device in situ, thus avoiding zero drift. In 14 patients with mostly severe head injury (Glasgow Coma Scale score of 8 or lower in 10 patients) and 19-84 years old monitoring was carried out during treatment in the intensive care unit. ICP values were checked by repeating functional tests of the monitoring system, by serial cranial CT, and by a study of the clinical outcomes. Four patients died. There were no technical problems or infections. Clinically reliable data were obtained in 10 patients. The ICP shown was correlated with all other parameters; it was lower than would be expected in 1, and higher in 3 patients. With six simultaneous measurements with Gaeltec ICT/b, Camino subdural or an intraventricular catheter system the values were found to correlate only in 1 case. Experimental and clinical data suggest that the Spiegelberg-monitored ICP is somewhat higher than the ICP shown by other epidural systems. Clinical trials will be continued.
Subject(s)
Craniocerebral Trauma/physiopathology , Intracranial Pressure , Monitoring, Physiologic/instrumentation , Adult , Aged , Aged, 80 and over , Craniocerebral Trauma/diagnosis , Epidural Space , Female , Glasgow Coma Scale , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
In order to check the correct position of the fibula in the Incisura fibularis tibiae by means of X-ray, four radiological parameters could be distinguished in patients with surgically or conventionally treated fractures of lateral malleolus. In spite of easy access, inserting the fibula into the incisure can be difficult in the case of bony or ligamentous injuries of the distal tibiofibular syndesmosis. With the help of these easily measurable X-ray parameters, an incongruence in the distal tibiofibular syndesmosis, which have to be corrected in any case, can easily be detected. The clinical relevance of these results could be verified in 105 patients.
Subject(s)
Ankle Injuries/diagnostic imaging , Fibula/diagnostic imaging , Fractures, Bone/diagnostic imaging , Tibia/diagnostic imaging , Adult , Female , Humans , Male , Middle Aged , RadiographyABSTRACT
Between 1958 and 1986 21 fractures of the femur in Osteodystrophia deformans (Paget's disease) were treated at the accident hospital Meidling; of these 13 patients were female and 8 of male. The average age was 73.4 years. In two cases the basic illness was known, in 19 cases the fracture was the first manifestation of the illness. In 7 cases a polyostotic manifestation was evident. The fractures were localized as follows: 7 in the proximal, 7 in the middle, 1 in the distal third of the shaft, 5 subtrochanteric, 1 supracondylar. Apart from one subtrochanteric torsion fracture, all were flexure fractures without splinters. 19 fractures were stabilized by an operation: 17 by intramedullary nailing (with cerclage), 1 steep plate, 1 Ender nail. One case was treated by an extension, whereas in one case no operation was performed. The following complications were observed: one fracture of the steep plate, one delayed healing of the fracture after intramedullary nailing. No infections could be observed. In general, healing of the fracture in Osteodystrophia deformans does not seem to be delayed. The different possibilities of intramedullary nailing of the femur - possibly together with osteotomies to eliminate curvature - can be recommended for fractures in Osteodystrophia deformans.
Subject(s)
Femoral Fractures/etiology , Fractures, Spontaneous/etiology , Osteitis Deformans/complications , Adult , Aged , Aged, 80 and over , Bone Plates , Bone Screws , Female , Femoral Fractures/diagnostic imaging , Femoral Fractures/surgery , Fractures, Spontaneous/diagnostic imaging , Fractures, Spontaneous/surgery , Hip Prosthesis , Humans , Male , Middle Aged , Osteitis Deformans/diagnostic imaging , RadiographyABSTRACT
The ligaments of the wrist joint were dissected on ten hands of corpses fixed with formalin. A two and a half magnifying lens was used during the dissection. The following structures could be discerned: a radial and an ulnar collateral ligament and the dorsal radiocarpal ligament, which are all capsular ligaments. Furthermore the intracapsular palmar group of ligaments, which could be divided into five different parts, and the intracarpal (interosseous) ligaments, which stabilize the bones of the proximal and distal carpal row. The exact knowledge of the anatomic standards and proportions in the wrist joint will be a fundamental step to improve the present treatment of the carpal instability.
