[Acute myocardial infarction after blunt polytrauma -- successful coronary intervention]. / Akuter Myokardinfarkt bei stumpfem Polytrauma mit erfolgreicher katheterinterventioneller Therapie.

Acute myocardial infarction following blunt chest trauma is a well reported but rare finding. Especially in severely injured patients the optimal therapy of the myocardial infarction is not well established, since anticoagulants, platelet aggregation inhibitors or thrombolytics are frequently contraindicated under these conditions. We report a case of a 41-year-old man, who presented with an acute myocardial infarction in combination with a severe polytrauma (multiple rib fractures, hematothorax, pelvic bone fractures, multiple injuries of intestinal organs) after a motorcycle accident with a blunt chest and abdominal trauma. After surgical treatment of the injuries of the bones and the intestinal organs a coronary angiography was immediately performed. The left anterior descending and the circumflex coronary artery were occluded in the mid-portion of the vessels. Coronary recanalization by PTCA and the implantation of coronary stents were successful in both vessels. Despite of a non-optimal blood flow after recanalization and stenting in one vessel (LAD TIMI II flow after recanalization), and a non-optimal accompanying medical therapy, during and after intervention (intravenous heparin starting 8 hours after the coronary intervention and platelet inhibitors starting 4 days after the intervention) the coronary angiogram after 2 months documented both vessels patent without a reocclusion or a restenosis. The case report documents, that in traumatic myocardial infarctions the treating of both, the attending injuries and the myocardial ischemia, is feasible. Early coronary angiography and coronary interventions, with or without stent-implantation, are indicated, even in cases in which an adequate accompanying medical therapy with heparin and platelet inhibitors is contraindicated.

Ganglion of the hip: report of five cases.

Ganglion of the hip is a rare cause of inguinal swelling. Ultrasound examination and MRI lead to the correct diagnosis. Resection should be considered for large ganglia and in cases with impairment of neighboring structures. Conservative treatment may suffice in small and asymptomatic ganglia.

[Bilateral traumatic elongation of the distal biceps tendon]. / Beidseitige traumatische Elongation der distalen Bizepssehne.

The rupture of the distal biceps brachii tendon involves characteristic functional deficits and clinical findings that allow easy diagnosis. Well-established surgical techniques will usually largely restore strength of flexion and supination. Lacerations without complete disruption of the tendon, however, pose diagnostic problems due to the absence of the typical gap in the course of the tendon. Our case of a bilateral traumatic elongation of the distal biceps brachii tendon demonstrates the value of clinical history, physical and sonographical examination that lead to the accurate diagnosis and adequate surgical treatment of this rare injury.

[Corrective osteosynthesis of the proximal femur]. / Zur Korrekturosteosynthese am proximalen Femur.

Posttraumatic malunions after fractures in the coxal femur area must be corrected if the deformity has reached a certain range, and individual aspects must be considered. Non-weight bearing, painful femoral neck pseudarthrosis absolutely requires osteotomy. With correct technique the deformities can be usually corrected and the results are good. This is shown in our series comprising 83 cases.

[Management of pertrochanteric femoral fractures. Bundle nailing or dynamic hip screw]. / Zur Versorgung pertrochantärer Femurfrakturen. Bündelnagelung oder dynamische Hüftschraube.

In a 8 year period (1981-1988) pertrochanteric fractures treated by elastic round nails (ERN) or dynamic hip screw (DHS) are investigated retrospectively. In spite of the more expense operative technical procedure, complications with DHS are rarer, and hospitalisation shorter, with low mortality.

[Expert assessment in the evaluation of the so-called rotator cuff rupture of the shoulder]. / Die gutachterliche Beurteilung bei der sog. Rotatorenmanschettenruptur der Schulter.

The tear of the rotator cuff only in rare occasions is caused by an adequate trauma. Degenerative changes in elderly patients mostly are the reason for the defect called "trophic perforation". In the operative treatment of such lesions an exact description of the macroscopic findings and the histological investigation are necessary.

[Evaluating histologic findings of the rotator cuff of the shoulder]. / Zur Wertung histologischer Befunde aus der Rotatorenmanschette der Schulter.

Tearing of the rotator cuff is normally due to degenerative changes of the supraspinator tendon. The vascular situation as well as histological findings in elderly patients--oedema, necrosis and hyalinosis--are reasons for the defect. A classical rupture caused by a real trauma is very rare; it is therefore better to call these typical findings "rotator cuff defect". Regular histological examination is necessary for the classification as traumatic rupture or degenerative defect.

[Eosinophilic granuloma. Risk of fracture and rare site]. / Das eosinophile Granulom. Frakturgefährdung und seltene Lokalisation.

The eosinophilic granuloma of bone, Letterer-Siwe's disease and Hand-Schüller-Christian's disease are integrated under the conception Histiocytosis X. The same patho-histological findings, especially on bone and the observation that the 3 diseases can change one into the other are the reason for this conception. In the past the very different prognosis of the 3 diseases was the reason for difficulties of the classification and the therapy. In Letterer-Siwe's disease with bad prognosis and HSC with uncertain prognosis conservative therapy is mostly indicated. The eosinophilic granuloma in monotopic and polytopic localisation normally requires surgical procedure usually the excision of a specimen for the diagnosis. In special localisations with the fracture or the possibility of a fracture operative procedure with resection, bone grafting and osteosynthesis in order to get bone stability are indicated. 2 cases with special localisation are described.

[Treatment and results in severe craniocerebral trauma]. / Behandlung und Ergebnisse beim schweren Schädelhirntrauma.

Treatment of severe craniocerebral traumas in medium and major hospitals not provided with special neurosurgical equipment requires particularly close interdisciplinary cooperation between surgeons, neurologists and anaesthesiologists. CT facilities are an essential prerequisite for best possible patient care. Patient safety during the posttraumatic and postoperative phases is improved by measuring the intracranial pressure. Whereas corticosteroid treatment may be arguable, barbiturate treatment should presently not be a routine procedure because of its side effects and high rate of complications.

[Infected pseudoarthroses of the tibia shaft. A collective study]. / Infizierte Pseudarthrosen des Tibiaschaftes. Sammelstudie.

A clinical report on 252 cases of infected pseudarthroses of the tibia is given: 72.6% after an open fracture. 218 underwent one stabilising procedure, 59 were stabilised twice to 4 times. In 201 cases stabilisation by external fixation, 45 stabilisations by plate osteosynthesis; 234 sequestrectomies, 280 grafts with autogenous cancellous bone, 10% amputations.

Biomechanics of the femoral neck. Calculation of pressure and tension distribution in the human femoral neck, applying principles of the theory of elasticity and strength of materials.

Theoretical aspects on the influence of the shape of the human femoral neck in terms of tension intensifying slots are presented. Static stress is calculated. It is shown that tension in the cranial periphery of the neck is twice as high as expected. The pressure at Adam's arc is 1.5 times higher. Further it is shown that tension does not increase from neutral centre to periphery in a linear but in a parabolic function.

[Valgus osteotomy in treatment of osteoarthrosis of hip (author's transl)]. / Die Valgisationsosteotomie zur Behandlung der Koxarthrose.

The article reports on Bombelli's theory on the genesis of arthrosis of the hip. Clinical experience has shown that valgus and extension osteotomy is indicated in dysplasia arthrosis, in cystic changes and formation of osteophytes. Although the good clinical results cannot be accepted as a proof of the biomechanical deliberations, they do extend the range of indications pointing to surgery of the diseased hip joint performed for the purpose of preserving the femoral head.