[Surgical or conservative therapy of rupture of the lateral ligament of the ankle joint?]. / Operative oder konservative Therapie der Aussenbandruptur am oberen Sprunggelenk?

To determine whether operative treatment is superior to conservative therapy, 60 patients were randomized to surgical suture and cast immobilisation for six weeks (n = 30) or cast immobilisation alone for the same time (n = 30) for acute rupture of the ligaments of the ankle. Variables of well being (ability to work, to do sports, dysesthesia, pain during exercise, swelling, tendency for recurrent distorsion), stability (dislocation and tilting of the talus on X-ray examination) and the radiological evidence of arthrosis were chosen as endpoints. Complete follow-up was obtained one year after the accident. In both groups we did not find any evidence of arthrosis one year after the accident. No significant differences were found between the study groups neither for the parameters of well being nor for objective criteria of stability. No correlation was found between well being and stability of the ankle joint. These results suggest that for the chosen endpoints no treatment modality can be recommended after one year follow-up. Only long-term studies using incidence of arthrosis as the most important endpoint will be able to answer the question whether conservative or operative treatment of rupture of the ankle ligaments is superior.

[Indications for open Ender nailing]. / Indikationen zur offenen Ender-Nagelung.

In some sub- or pertrochanteric fractures of femur it is sometimes most difficult or even impossible to carry out an closed reduction on the extension table. In these cases an open reduction has to be performed. When such an open reduction is necessary, this should not give reason to dispense with the advantages offered by the Ender nailing method and select another technique of osteosynthesis. An early mobilisation, which is of particular importance to old patients, can be achieved best by the aforementioned osteosynthesis.

[Treatment of per- and subtrochanteric femoral fractures in conjunction with coxarthrosis]. / Versorgung per- und subtrochantärer Oberschenkelfrakturen bei gleichzeitig vorliegender Coxarthrose.

When both a coxarthrosis and a sub- or pertrochanteric fracture of the femur are simultaneously present, it is, as a rule, most difficult to carry out a closed reduction of the fracture on the extension table. In almost all cases, an open reduction has to be performed. When such an open reduction is necessary, this should not give reason to dispense with the advantages offered by the Ender nailing method and select another technique of osteosynthesis. An early mobilisation, which is of particular importance to old patients, can be achieved best by the aforementioned osteosynthesis. On the other hand, the implantation of a resection prosthesis as the logical treatment of a coxarthrosis coinciding with a per- or subtrochanteric fracture of the femur is in most cases out of question when the patient has not been sufficiently prepared, and should therefore be reserved for surgical intervention at a later date.

[Giant cell tumor of the ulna, treated by resection and bone grafting]. / Riesenzellgeschwulst der Elle, behandelt durch Resektion und Spanplastik.

Bone tumours with a tendency to recur or whose benign nature is doubtful should be treated by resection of the tumour-bearing segment and not by simple curettage, as this does not provide for complete excision. This technique is illustrated by the example of an atypically situated giant-cell tumour of the ulna in a child, which was treated by en bloc resection, following which the defect was bridged by a cortico-cancellous bone graft.

[Necrosis of the head of the femur as a complication of the medial fracture of the neck of the femur (author's transl)]. / Die Femurkopfnekrose als Komplikation der medialen Schenkelhalsfraktur.

In spite of the progress achieved in accident surgery, medial fractures of the neck of the femur still present a lot of problems. The rate of success achieved in most other cases of bone fracture is not obtained here. The necrosis of the head is the most frequent and most serious complication of the medial fracture of the neck of the femur. Its formation is influenced by different factors, such as fracture line, dislocation of the fragments, time and method of reposition, and method of osteosynthesis. A prognosis whether a necrosis of the head of the femur is to be expected or not can be made when these factors are taken into consideration. So, by means of a primary alloarthroplasty, it will be possible to spare the patient a later reconstruction.