[Early diagnosis and management of femur head necrosis in young adult age]. / A fiatal felnöttkori combfejelhalás korai felismerése és gyógyítása.

There are a lot factors in the genesis of the ischemic femoral head necrosis. In the early stage the intraosseous pressure increases without any clinical or radiological sign. The disease is often bilateral. The early diagnosis (NMR) is essential in the treatment. In the case of a severe femoral head necrosis the radiological investigation of the other side is obligatory, in order to diagnose the early stage of the disease and to prevent the progression of the collapse with core decompression. The object of the adequate treatment of the collapsed femoral head is to release the pain and to avoid the total destruction of the femoral head. The untreated femoral head necrosis results in a painful, arthritic hip, where spontaneous regeneration is limited, and takes 8-10 years. With osteotomy and revascularisation the results are good, and the regeneration takes about 2-3 years. As a result of this treatment, the patients have a moderately limited function, and minimal limping. Rehabilitation is possible into the original profession, or into a somewhat easier job. Remodellation of the femoral head in younger patients following the revascularisation procedure has been observed in our experience in the last few years.

[Is remodeling still possible after collapse in femur head necrosis?]. / Ist die Remodellierung nach Kollaps bei Hüftkopfnekrose doch möglich?

A case of a femoral head necrosis, with collapsed joint surface after fracture of the femoral neck will be presented. Following varisation osteotomy, the necrotic parts of the bone was removed and filled with cancellous bone. A standardized bone block of the iliac crest was implanted into the hole. After the operation the patient was painfree. The X-rays showed the improvement of the bony structure and later a spherical remodeling of the femoral head. This result is in opposition with the earlier opinion of the disability of femoral head remodeling in adults. It is technically very important to pack tight the hole in the femoral head with cancellous bone chips after necrectomy, and to ensure the revascularisation with vascularised bone block.

[Aseptic femur head necrosis and therapeutic possibilities by using a bone graft with a vascular pedicle]. / Az asepticus combfejelhalás és a kezelés lehetösége érnyeles csont beültetésével.

The review of the occurrence, etiopathology, classification and diagnosis of the aseptic necrosis of the femoral head is followed by the description of the method of transplantation of the vascular pedicled bone graft. During 5 years implantation of 12 vascular pedicled bone grafts in 10 young patients with severe and of major extension necrosis of the femoral head was carried out. The early result was in every case the quick and significant decrease of pains and that the necrosis did not progress. In the early stage the severe consequence of the necrosis the collapse can be prevented with core decompression. In a later stage the vascular pedicled revascularization of the femoral head may retain in young patients, beside adequate hip movements, the gait and the working capacity. This, though it is not a final solution, will give chance by gaining time to perform prosthesis operations later.

[Talus substitution using a vascular pedicled bone flap]. / Taluspótlás érnyeles csontlebennyel.

Authors report on the substitution of in consequence of complete talus luxation, missing talus. It succeeded with the transplantation of a free vascular pedicled bone block, gained from the crista ilei to retain the length of the extremity and to secure the gait of the patient without aid, finally to make the return to the former active life possible. The use of the method in similar cases was found to be unknown after a review of the literature. This case is an example demonstrating the growing significance of microsurgery in the traumatology.

[Management of lower leg fractures by external fixators and thermoplastic braces. Preliminary report]. / Lábszártörések kezelése fixateur externe és thermoplastikus sín alkalmazásával. Elözetes közlemény.

Authors describe their new combined method for treatment of lower leg fractures. To this a new type fixator was developed which makes dynamization also possible. The other novelty in this country is the use of functional external fixing brace. In all of the 38 patients they had succeeded to obtain healing. No complication was found until now.

[Management of upper arm fractures using a thermoplastic functional brace]. / A felkartörések kezelése termoplasztikus funkcionális sínnel.

Authors report on the functional bracing of the fractured humerus. The advantage of the method is the preserved muscle and joint function with the use of a brace. This means ease for the patient in respect of the personal hygiene and living conditions. In elderly patients all other type of fixation around the chest means a substantial danger to the patients life because of the breath's movements depression.

[Osteosynthesis of femoral neck fractures by double-cannulated screws (preliminary report)]. / A combnyaktörés osteosynthesise két cannulalt (furatos) csavarral. (Elözetes jelentés).

Authors report on a new osteosynthesis based on the double nailing of femoral neck fracture and screwing, and developed from the "Uppsala" double screwing. The preliminaries of the double cannulated screwing method, its advantages, the experiences gained in 30 cases operated in one year and the early results are described.

[Nondisplaced (impacted) femoral neck fracture--conservative or surgical treatment?]. / Die nichtdislozierte (eingekeilte) Schenkelhalsfraktur--konservative oder operative Behandlung?

The treatment of undisplaced femoral neck fractures, having been disputed for the past 50 years, is analysed on the basis of 111 observations during the period of 1981 to 1983. Osteosynthesis proved to be advantageous. Fixation with a three-flanged nail did not increase mortality rate, had no negative effect on late complications, while it could prevent dislocation and permitted full loading at an early stage.

[Method of fracture fixation using external fixation devices]. / A töréskezelés taktikája külsö rögzítök alkamazásakor.

An improvement of the results of treatment can be reached, beside respecting the indication of external fixateurs, with correct tactics of the treatment. Because of the disadvantages of the fixateur externe, we strive to restrict their use, to the time by all means necessary, and if possible to use other methods of fixation. This is motivated especially by the effect on fracture healing and the hindering of the movements and activity of the patient.

Significance of urgent (within 6h) internal fixation in the management of fractures of the neck of the femur.

The value of internal fixation of fractures of the neck of the femur within 6 h was assessed in a review of a 3-year series. Three groups were compared, in which the operation was performed within 6 h, between 6 and 24 h and after 24 h respectively. The time and quality of union and the incidence of collapse of the head of the femur were significantly better in the first group. The difference in the results between the other two groups was not significant. In view of these data the authors recommend the internal fixation of fractures of the neck of the femur within 6 h.

Patellar chondropathy. II. Ultrastructure, scanning electron microscopic studies.

A scanning electron microscopic study of the chondropathy of the patellar articular surfaces following knee injury was made. The early signs of degeneration were evident in the superficial membrane. Here, the fibres running parallel with the surface then turning deep become irregularly arranged, i.e. the amount of matrix embedding the fibres was reduced and the uncovered fibres became fragmented causing degeneration of the superficial membrane. During the progressive pathological process, as a result of the gradual deterioration of the interterritorial substance of the uncovered hyaline cartilage, spaces, fissures and deep pits were formed in the upper, then the lower, articular layers. The degeneration involved also the chondrons. With the disintegration of the chondrons the external and internal cell areolae disappear, the cell nests of chondrocytes are opened and the cells degenerate. Finally, the irregular cellular and fibrous structures and their remnants as well as the elements of connective tissue proliferation initially associated with the degenerative process can be visualized ultrastructurally.

Arthroscopy of the injured knee.

A rather neglected method suitable for examination of the inner side of the knee-joint is discussed. After describing the types of arthroscope and the advantages and disadvantages of different techniques, the arthroscopic picture of the inner formations of the knee-joint is described. Results achieved during a year are summed up and the importance of arthroscopy in early diagnosis is emphasized.