Unstable pelvic fractures in children.

A total of 3561 freshly injured children received treatment at the paediatric trauma department of the National Institute of Traumatology between 1984 and 1994. Out of these 38 (approx. 1%) had pelvic fractures. Based on the classification of Tile and Laer, 15 pelvic fractures were diagnosed to be unstable, from which 8 were polytraumatised, 4 shocked and 1 was a casualty. Run downs could be considered as the main cause of these fractures. Conservative treatment was provided for 13 unstable cases (bed rest: 5, band suspension: 1, femur skeletal traction: 4, femur traction and band suspension: 3). Surgery was performed in 2 cases (symphysis cerclage: 1, acetabulum plate o.s.: 1). Eleven patients were called in for late controls (after 3 years). Subsequent complications were: pain: 3, limb shortening: 4, lumbal scoliosis: 1, minor pelvic deformations: 4, partial necrosis of caput femoris: 2. The subjective complaints of 3 adolescent cases seem to be small in number, however, it is a fair assumption that the control period of 3-6 years later is not enough to form a comprehensive conception on the nature of early degenerative deformations occurring later, e.g. during adulthood. Because of further surgeries and examinations, correct traction and suspensional treatment can only be carried out with great difficulties regarding children. Therefore, posterior stabilisation of the pelvic ring must be planned with percutaneous sacroiliac pinning or screwing in unstable cases.

[Ossovenography as a diagnostic criterion of post-traumatic femoral head necrosis in internal fixation devices]. / Die ossovenographie als diagnostisches kriterium der posttraumatischen femurkopfnekrose bei liegendem metallimplantat.

Despite advances in the field of orthopedic surgery, necrosis of the femoral head still remains a serious problem. Under normal conditions magnetic resonance tomography (MRT) is the gold standard for early diagnosis. Because of magnetic interference, this technique is not applicable in the diagnosis of posttraumatic necrosis with internal fixation, however. This seems to be an ideal indication for ossovenography: contrast medium is injected into the femoral head under X-ray control and the venous flow is documented. Furthermore, it is possible to get histological samples from suspicious areas. Ossovenography was performed in 12 patients and the results were compared with histological samples. In every patient in whom necrosis of the femoral head was diagnosed by ossovenography (91.6%), we also found necrosis on histological examination. In one patient in whom physiological flow was found, there was a corresponding absence of necrosis in the histological sample. There were no complications during ossovenography. The results suggest that ossovenography is a promising and reliable method for early diagnosis of necrosis of the femoral head in the presence of internal fixation devices.

[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.

Yersinia enterocolitica infection of animals and human contacts.

Infective animal sources and persons in contact with animals were investigated for Yersinia enteroclotica. The 68 isolates from 3115 animals belonged to four serogroups. The most frequent was serogroup O3 (62 strains) found mainly in pigs (41 strains). The same serogroup was isolated from dogs (9 strains), cats (6 strains) and from other animals (6 strains). A total of 556 animals living in the Budapest Zoo were examined. Y. enterocolitica was isolated from the faecal specimens of one chimpanzee and one gibbon. Using the Widal-type agglutination, out of sera of 877 persons in contact with animals, 4.56% were positive with antigens O3 and O9, compared to 0.33% in healthy controls. The study indicates that beside the occasional role of other animal species, pigs should be regarded as the main source of human enteric yersinosis.

[Analysis of femoral shaft fractures (author's transl)]. / A combcsont diaphysis töréseinek elemzése.

Authors after having reviewed the literature analyse 157 healed cases from their own material of 198 femoral shaft fractures. Fractures between the subtrochanteric and supracondylar region has been considered. 2/3 part of the injured have been victims of traffic accidents, 1/6 part suffering severe polytraumatisation. From among the healed patients in 88 per cent an operation was carried out 76.8 per cent of which were medullary nailing following a broadened indication. In their patients treated surgically the fractures healed within 6 months in 75.4 per cent of cases. It is concluded that in the treatment of femoral shaft fractures the usual operative measures yield fast healing with good function. For multiple or comminuted fractures the use of other newer methods seems inevitable.

Incidence of non-cholera vibrios in Hungary.

In the period 1971 to 1976, 200 non-cholera vibrio (NCV) strains were isolated in Hungary; 18 of the cultures were derived from 34 729 faecal and 182 from 237 surface water samples. Ninety-two strains belonged to the Heiberg-Smith group I and 108 to group II. Two strains failed to give the string test and 3 were pteridine resistant. The strains were classified into 48 serotypes according to Smith's system. Faecal NCV strains belonged to serotypes 46 and 328; these serotypes did not occur in water. Of the 18 faecal strains 13 were isolated from 18 048 persons who had travelled in cholera-infected areas, and 5 strains from persons who had never left Hungary (2 from 4559 patients with diarrhoea and 3 from 6061 healthy individuals). These data indicate that although NCV are present in the environment, they play an insignificant role in enteric infections in Hungary.

A five-year survey of human Yersinia enterocolitica infections in Hungary.

Human infections associated with Yersinia enterocolitica in Hungary in the years 1969-1974 have been surveyed. During this period the public health laboratory network isolated 1355 strains from 1096 persons. The number of isolates according to sero-groups was: 1343 O3, 6 O9, 2 O1, 2a, 3 and 1 strain for O5, O6, O1O and O15 each. (ii) A total of 2192 serum specimens from patients gave positive agglutination reaction with antigen O3 in 26.8%, with antigen O9 in 3.2%. (iii) Fifty-six per cent of bacteriologically positive persons had enteritis. Other clinical forms (pseudoappendicitis and other abdominal complaints, erythema nodosum, rheumatoid arthritis) were encountered in O 1-2.7%. Symptomless excreters of Y. enterocolitica amounted to 23.1% of all positive persons. (iv) Patients with enteritis and symptomless excreters were rather evenly distributed between 10 and 60 years of age; 1--9-year-old children were affected more frequently (47.7% of all positive persons). Six distribution was, males: females = 1.5 : 1. In seasonal incidence yersiniosis differed from other enteric diseases: it showed a peak in the autumn-winter months. Sporadic cases and family outbreaks were the most frequent; epidemic infections in nurseries were also recorded. (v) Out of 59 animal strains 39 group O3 cultures were isolated from pigs, which may be assumed as the most important reservoir of yersinosis in Hungary.