[Intra- and perioperative complications in the stabilization of per- and subtrochanteric femoral fractures by means of PFN]. / Intra- und perioperative Komplikationen bei der Stabilisierung von per- und subtrochantären Femurfrakturen mittels PFN.

In the period from 2/98 up to 6/99, fractures of the proximal femur of 70 patients (phi 79.2 a), were treated with a proximal femur nail (PFN((R))). The aim of this retrospective analysis was to evaluate intra- and perioperative complications. The reports of the operation and the anaesthesia documentation sheets have been worked out, all X-rays have been measured, and evaluated along exactly defined parameters. Problems or complications were found in 18 cases (25,7%). In 7 cases (10,0%) these problems could be solved during operation. The "Z-effect" seen in 5 cases (7,1%) and the "cut-out" of the sliding-hip-screw in 6 cases (8,6%) were the most frequent complications. The main reason was a bad primary reposition in varus with a CCD-Angle less than 125 degrees.

Bone tunnel remodeling at the site of biodegradable interference screws used for anterior cruciate ligament reconstruction: 5-year follow-up.

PURPOSE: The purpose of this prospective study was to review, using expanded clinical-assessment tools, the long-term results of the local effects of a bioabsorbable interference screw (copolymer 85/15 D,L lactide/glycolide) in anterior cruciate ligament (ACL) reconstruction. TYPE OF STUDY: This prospective study was initiated in May 1993. The inclusion criteria for patient selection included rupture of the ACL in athletic patients without involvement of the collateral ligaments, arthroscopic ACL reconstruction using middle third of the ligamentum patella, and magnetic resonance imaging (MRI) and plain radiographic examinations of the knee joint during follow-up. MATERIALS: Between May 1993 and October 1994, 32 patients were enlisted in the study; 48 patients did not fit the inclusion criteria. There were 25 men 7 women. The average age was 29.1 years (range, 19 to 50 years). There were 21 right knees and 11 left knees. The follow-up examinations were performed by an independent examiner. There were 28 patients available for follow-up at a medium of 5.2 years (range, 4.1 to 6.4 years). The evaluation included various testing systems (i.e., OAK, IKDC, Lysholm) as well as MRI and plain radiographic studies to investigate the longevity of the implant and potential adverse effects of this new bioabsorbable material. RESULTS: The clinical results were good. The OAK score (Orthopädische Arbeitsgruppe Knie) showed 93% excellent and good results, and 7% fair results. The IKDC and Lysholm scores were 92% and 96% good and excellent results, respectively. MRI showed bone remodeling and new bone formations at the site of the implant in the femoral as well as in the tibial bone tunnel at follow-up. No cystic or osteolytic changes where seen on MRI or plain radiographs. CONCLUSIONS: This study showed the correlation between histology and MRI: there was minimal surgical-site edema, minimal reaction to this material, and complete replacement by new bone formation of the previous site of this implant. At 5 years, this bioabsorbable interference screw appeared clinically safe and effective for fixation of bone blocks during ACL reconstruction and MRI showed complete absorption and replacement with new bone.

Half pipe cannula for shoulder arthroscopy.

Shoulder arthroscopy makes it possible to diagnose and to reconstruct different pathologies. This article describes the use of a half pipe cannula for changing instruments in shoulder arthroscopy without using a closed cannula system. The use of this new device is not an alternative to standard cannula systems, but it is very helpful for changing different arthroscopic instruments without altering the soft tissues, thus minimizing postoperative swelling.

[Arthroscopy of the upper ankle joint. A retrospective analysis of complications]. / Arthroskopie des oberen Sprunggelenks. Eine retrospektive Analyse der Komplikationen.

The purpose of this retrospective study was to analyse the complications of our arthroscopic procedures at the ankle joint. In all patients we evaluated the treatment protocols and in 111 patients (79.3%) we also evaluated the clinical and radiologic results. All in all we have found complications in 14 patients. In 4 cases we have seen a delayed wound healing, in 2 cases a superficial infection, in 3 cases a deep infection, in 3 cases a neural damage and in 2 cases a phlebothrombosis. Our study show, that the complication rate could be minimized by detailed knowledge of the anatomy, exact preoperative diagnostic and planing of the operation and careful preparation of the portals. The use of a laser also shows a tendency to a lower complication rate.

Serial magnetic resonance imaging evaluation of operative site after fixation of patellar tendon graft with bioabsorbable interference screws in anterior cruciate ligament reconstruction.

Magnetic resonance imaging (MRI) is accepted as the imaging procedure of choice for showing internal derangement of the knee. In contrast to metal implants, bioabsorbable interference screws do not produce an artifact and provide an opportunity to expand the evaluation of the postoperative anterior cruciate ligament (ACL) ligament repair. There is the potential to evaluate the implant, the graft, the adjacent tissue, and the surgically created bone tunnels. The purpose of this study was to evaluate with MRI the postoperative site of ACL patellar tendon autografts in which bioabsorbable screws were used for fixation. It was hypothesized that a time line of bone tissue changes resulting from this type of surgery could be developed based on the expanded evaluation of MRI. From January 1993 through October 1997, 270 patients underwent surgical repair of a disrupted native ACL. There were 173 men 97 women; the average age was 25.1 years, (range, 17 to 50 years). There were 155 right knees and 115 left knees. In addition to the conventional postoperative clinical assessment and plain film radiographs, opportunistic MRIs were obtained with the patient's permission. The examinations were performed at different postoperative intervals from the third postoperative day to 4 years postoperatively. A total 206 MRIs from various time intervals were available for study. The study protocol was designed to look for loss of integrity of the screws, adjacent fluid collection, tunnel widening, and tunnel healing or narrowing. The hypothesis was substantiated in this study. The use of MRI provided observations not available by other imaging methods. The absence of metal implants for fixation provided an opportunity to examine the adjacent tissue in detail and to form a time line of the tissue response in this type of surgery.

Serial magnetic resonance imaging evaluation of a bioabsorbable interference screw and the adjacent bone.

The purpose of this prospective study was to review, using expanded clinical assessment tools, the initial use of a bioabsorbable interference screw (copolymer 85/15 D, L lactide/glycolide) in anterior cruciate ligament (ACL) reconstruction at the Wels Hospital, Austria. The study enlisted 32 patients of whom 28 were available for follow-up at minimum of 2.5 years. Since the implant material was new and the screw would not show on plain film radiographs, the clinical assessment was expanded beyond the usual historical and physical findings. The evaluation included opportunistic knee joint aspiration and repeat magnetic resonance imaging (MRI) studies to investigate the longevity of the implant and potential adverse effects of this new bioabsorbable material. The knee joint aspirations showed no infection. Serial MRIs showed the physical presence of the screw to remain intact for 4 months and disappear in 6 months. The MRIs showed minimal collection of edema around the bone tunnels that resolved by 12 months. There were no symptoms or adverse clinical result correlated with the MRI evidence of edema. There was temporary bone tunnel expansion. The clinical results were good. The OAK-score (Orthopädische Arbeitsgruppe Knie) showed 89.5% excellent and good results, 7% fair results and 3.5% poor results. The average score was 90.7 points (range, 63 to 100 points). The knee joint stability measured with the KT-1000 arthrometer showed 93% to have a 3-mm or less difference compared with the unoperated knee. This bioabsorbable interference screw appeared safe and effective for fixation of bone blocks during ACL reconstruction while producing no occult infection or adverse clinical response during the degradation process.

[Results of reconstruction of anterior cruciate ligament ruptures. Use of resorbable interference screws (minimum follow-up of 2.5 years)]. / Ergebnisse nach Rekonstruktion vorderer Kreuzbandrupturen. Verwendung resorbierbarer Interferenzschrauben (minimum Follow-up 2.5 Jahre).

The purpose of this study was to assess the effects of biodegradable interference screw use in ACL reconstruction beyond the usual clinical historical and physical findings. The use of this material for interference screws has potential benefits if the problems of inflammation are minimal and the fixation properties are sufficient. There is no need for a second operation for removal and no complicating factor if revision surgery is necessary. A prospective study was initiated in May, 1993 to evaluate the use of biodegradable interference screws (Instrument Makar). Our patients were evaluated with the aid of the common OAK-score. The overall evaluation showed 89.5% excellent and good results, 7% fair results and 3.5% poor results. The average score was 90.7 points (63-100 points). The measurement with the arthrometer (KT 1000) showed a difference of up to 3 mm as compared to the knee joint not operated on in 24 (93%) of the patients. Four patients showed a 3 to 6 mm difference. A tibia translation of more than 4 mm was not measured in any case. The biodegradable interference screw is a safe and effective interference screw for fixation of the bone blocks for ACL reconstruction.

[Resorbable interference screws. Histologic study 4.5 years postoperative]. / Resorbierbare Interferenzschrauben. Histologische Untersuchung 4,5 Jahre postoperativ.

The use of degradable implants in recent years has brought not only good results. Foreign body reactions to implantation of degradable polymers clearly curtailed the initial expectations. Bioabsorbable polymers have been used for sutures, vascular clips, and fixation implants for both intra-articular fractures and malleolar fractures. In the literature these implants are controversial. Potential benefits remain for the use of this material for interference screws if the problems of inflammation are minimal and the fixation properties are sufficient. There is no need for a second operation for removal. In one patient, 4,5 years after to implantation of an degradable interference screw (Copolymer 85/15 D,L lactide glycolide; Biologically Quiet, Instrument Makar, Inc. Mount Hope, MI 48864, USA) we took an biopsy and made histological examinations. No foreign body reaction or inflammation signs could be detected.

[Conservative treatment of stable finger joint dislocations using the Stack splint]. / Die konservative Behandlung stabiler Mittelgelenkluxationen mit der Stack'schen Schiene.

Stable dislocations of PIP-joints should be treated by early motion. It is important to gain full extension from the very beginning of treatment. The anatomy and biomechanics as well as the use of a Stack button-hole splint is reported. 28 patients with 32 dislocations have been treated for two to four weeks with excellent results.

Ulnar collateral ligament: differentiation of displaced and nondisplaced tears with US.

PURPOSE: To determine the usefulness of ultrasound (US) in the differentiation of displaced and nondisplaced tears of the ulnar collateral ligament (UCL). MATERIALS AND METHODS: A 7.5-10-MHz linear-array transducer was used to examine 69 patients in whom a UCL tear was suspected, 43 of whom also underwent surgery. The US findings were compared with those obtained at surgery. RESULTS: Results of US corresponded to results of surgery in 37 of 43 patients. Findings were false-positive in six patients. Twenty-six patients were treated conservatively with thumb casts. These patients showed stability and free range of motion at the first metacarpophalangeal joint at clinical follow-up (9-13 months). CONCLUSION: Sonography is useful for evaluating nondisplaced and retracted tears of the UCL and determining the need for surgery.

[Initial experiences with the humerus interlocking nail]. / Erste Erfahrungen mit dem Oberarmverriegelungsnagel.

A preliminary report is given on the good results of eleven patients, who had been treated with a locking nail for a fracture of the humerus at three different trauma departments. No non-union, infection or radial palsy has been seen nor was there any neurovascular complication intraoperatively. Four patients had misalignments of up to 15 degrees, whereof three of them had combined varus-recurvation-angulations without functional or cosmetic sequelae. All but one had excellent functional results six months postoperatively. Bone healing could be confirmed three months postoperatively. Only transverse and spiral fractures of the second to fifth sixth had been treated until now, though open fractures up to the second degree can be managed too. Finally, some technical issues are considered, which include a better guiding device, the use of cancellous screws for proximal looking, a more oblique position of one of the proximal screwholes to obtain some kind of interfragmentary compression for appropriate fractures, and the use of a Williams-screwdriver.

A locking nail for fractures of the humerus.

We reviewed 19 patients treated for upper arm fractures using Seidel's locking nail system, which allows for early function after operation. The overall results were good with no cases of pseudarthrosis, infection or radial nerve palsy. All the patients regained full shoulder movements with no evidence of rotator cuff lesions.

[Elbow joint dislocation. Diagnosis, therapy, results]. / Die Ellbogengelenksluxation. Diagnostik, Therapie, Ergebnisse.

Thorough knowledge of the anatomy and biomechanics in the elbow joint together with an special reference to constitutional variations is an important factor in understanding the pathomechanisms of its dislocation. We are presenting 27 case-reports of elbow-dislocations treated at the I. University Clinic for Traumatology in Vienna between 1979 and 1983. The so-called carrying angle showed no pathological deviation besides a tendency to cubitus valgus and hence elbow-joint to dislocation. Our results showed clearly that conservative treatment is possible and advisable in most cases. Only dislocation with osseous lesions and/or a tendency to redislocation after reduction should be operated on.

[Prevention of thromboembolism in para-articular femoral fractures of the hip--results of a prospective randomized study of heparin-DHE and ASS-DHE]. / Thromboembolieprophylaxe bei hüftgelenknahen Oberschenkelfrakturen--Ergebnisse einer prospektiven randomisierten Studie zwischen Heparin-DHE und ASS-DHE.

The effectiveness of prophylaxis of thromboembolism either by acetyl-salicylic-acid (ASA) 0.5 g + dihydroergotamin (DHE) 2.5 mg three times a day or by Heparin 5000 IU + 0.5 mg DHE (HDHE) three times a day was compared in 404 patients, elder than 55 years, with fractures close by the hip joint. Effectiveness was proved daily clinical controls, perfusion scintigraphy on the day after admission, the fourth postoperative day and the day before discharge and by autopsy of the died patients. Clinical manifest thrombosis were seen on the operated legs in the HDHE-group in 7.6% of the patients, in ASA-DHE-group in 15.6%, on the not operated leg under prophylaxis by HDHE in 3.8%, by ASA-DHE in 4.1% of the patients. Increased postoperative bleeding could be found under HDHE in 16.1% of the patients, under ASA-DHE in 9.3% of the patients, wound haematoma in 9.5% under HDHE and in 5.7% of the patients of the ASA-DHE-group. Superficial wound infections occurred under HDHE in 8.1%, under ASA-DHE in 5.7% of the patients, deep infections under HDHE in 0.5% and under ASA-DHE in 1.6% of the patients. Gastrointestinal bleeding under HDHE in 0.5% of the cases and under ASA-DHE in 3.1% of the cases. Prophylaxis had to be discharged in 7.6% of the patients of the HDHE-group and of 19.7% of the ASA-DHE-group. Pathologic perfusion scars should be found in 54.0% of the patients of the HDHE-group and in 54.9% of the ASA-DHE-group. Pulmonal perfusion became worse despite of prophylaxis by HDHE in 15.6% of the cases and despite prophylaxis with ASA-DHE in 17.6%. Pulmonal perfusion became better under HDHE in 11.9% and under ASA-DHE in 12.4% of the cases. The mortality was 9.7%. Fatal thromboembolism occurred under HDHE in three patients (1.4%) and under ASA-DHE in three patients too (1.6%), after subcapital fractures in 0.5%, after pertrochanteric fractures in 2.1% and after subtrochanteric fractures in 6.25% of the patients without any significant difference between the two groups of prophylaxis. Fatal gastrointestinal bleeding had to be remarked in 1.0% of the patients of the HDHE-group and in 2.1% of the ASA-DHE-group, fatal infections in 0.5% of the patients of the HDHE-group and in 1.6% of the ASA-DHE-group. Fatal cardinal infarction could be seen under HDHE in 1.9% of the patients, under ASA-DHE no fatal cardial infarction occurred.(ABSTRACT TRUNCATED AT 400 WORDS)

[Tendon injuries of the knee joint extensor mechanism]. / Sehnenverletzungen des Kniegelenkstreckapparates.

Diagnosis, aetiology and therapy of injuries to the extensor mechanism of the knee joint are presented. 22 cases of ruptures and discisions of the lig. patellae or the quadriceps tendon could be reexamined. All cases but one, with operation within the first week after injury, suturing with absorbable or non absorbable material, immobilisation for 6 weeks and following physical therapy, had a good functional result. No rerupture occurred. In one case a limitation of the range of movement had to be seen afer an open discision of the lig. patellae. After transposition of the tuberositas tibiae, discission of the scares and functional therapy a good result could also be achieved.

[Dislocation of peroneal tendons]. / Die Luxation der Peroneussehnen.

From 1973 to 1985, 23 patients with a total of 25 peroneal tendon luxations were operated on. All luxations were successfully treated, although 1 patient had a recurrent dislocation and had to be operated on twice. At follow-up an average of 8.4 years later, 18 patients with 20 luxations were free of symptoms. In 3 patients there was a minimal loss in the range of movement in the ankle joint; in 1 the sensitivity of the skin distal to the incision was diminished and in 1 friction was found in the tendon sheath. The possibility of diagnosing these injuries precisely by tenography of the peroneal tendons and a tangential X-ray of the retromalleolar sulcus is pointed out. All fresh luxations were adequately treated by suturing the retinaculum; in some cases the sutures were secured with an additional screw. In patients with chronic luxation the procedure of Kelly can be recommended.

[Dislocation of the scaphoid bone of the hand]. / Zur Luxation des Handkahnbeins.

After presentation of the kinematic of the scaphoid and the mechanism of the luxation of the scaphoid, the importance of the correct diagnosis of a wrist instability, after this injury, is demonstrated. After closed reduction a lateral, anteroposterior and a stress-radiography in ulnar-and radialstress has to be done. If the gap between the scaphoid and lunate is widened, a wrist instability exists. Another sign for a wrist instability is a scapholunate angle with more than 70 degrees and a wrong position between radius, scaphoid, lunate and capitate. The problems of conservative treatment are presented and primary repair of a wrist instability with suture of the ruptured ligaments and temporary Kirschner-wire fixation is recommended.

[Possibilities for radiologic imaging of the retro-malleolar groove]. / Möglichkeiten zur radiologischen Darstellung der retromalleolaren Gleitrinne.

The possibilities of X-rays of the retromalleolar groove of the peroneal tendons have been proved. The CT-technique is simple in handling and gives most information because of the possibility to judge as well the peroneal tendons, the haematoma as the retromalleolar groove. It is fit for diagnosis and for preoperative planning of the therapy. A standardized technique of the tangential projection of the retromalleolar groove is presented. This technique is more difficult than CT, but, if it is done correctly, the information is from the same value than the information of the CT. X-rays of the ankle in the posterior-anterior and lateral projection are only of value in cases with an avulsion-fracture of the peroneal retinaculum. The tomography of the lateral malleolus gives not more information.

[Experimental study for clarification of the pathogenic mechanism in traumatic peroneal tendon dislocation]. / Experimentelle Untersuchung zur Klärung des Pathomechanismus der traumatischen Peroneussehnenluxation.

An experimental trial was performed to illustrate the causative mechanism of peroneal tendon luxation. It seemed that traumatic luxation of the peroneal tendons was found to originate in dorsiflexion, abduction and eversion of the forefoot. On the other hand, unless the peroneal muscles are at high tension and the ankle joint supported with a high shoe or similar a trimalleolar ankle fracture is likely. The depth of the retromalleolar groove is only one more factor predisposing to luxation of the peroneal tendons.