[Unreamed antegrade humeral interlocking nailing]. / Unaufgebohrte antegrade Oberarmverriegelungsnagelung.

In a prospective clinical study 111 fractures of the humerus in 109 consecutive patients were stabilized with unreamed antegrade interlocking nailing. 97 patients were evaluated with individual follow-up, in the mean at 24.2 months postoperatively. Mean fracture consolidation time was 12.3 weeks (9-16 weeks). Five patients presented a non union. At follow-up 19 patients had a limitation in motion of the shoulder, in the mean with 20% compared to the opposite side. Eight patients had permanent shoulder pain, in nine patients shoulder pain occurred during manual strain of the upper limb. Neither limitation of motion nor pain at the elbow region was present in all cases at follow-up. Ultrasound examination revealed in six cases a lesion of the rotator cuff, which was linked in these cases with permanent pain at the shoulder joint. In five patients a prominent nail tip at the entrance point caused a lesion of the rotator cuff with impingement syndrome. Eight out of nine preoperative palsies of the radial nerve recovered within a mean period of 4.3 months without operative measurements. Unreamed antegrade interlocking nailing of humeral fractures is a safe technique regarding consolidation rate with advantages regarding early mobilization of the upper limb. Careful suturing of the rotator cuff and countersinking of the proximal nail tip at the entrance point is a prerequisite in avoiding permanent lesions of the rotator cuff and shoulder pain.

Unreamed intramedullary nailing of femoral fractures.

Seventy-five patients with 81 femoral shaft fractures were treated with unreamed antegrade intramedullary nailing using a titanium alloy implant (AIM femoral nail, ACE Medical) with static interlocking. There were 73 closed fractures and 8 open fractures. Six patients had bilateral femoral shaft fractures. In two cases there was an ipsilateral fracture of the femoral neck, two patients had an ipsilateral intertrochanteric fracture, in one case there was a concomitant subtrochanteric fracture, and four patients had sustained an ipsilateral fracture of the acetabulum in addition to their femoral shaft fractures. In 43 cases (53%) the fracture of the femoral shaft was a comminuted type fracture. Thirty-nine patients (52%) had suffered multiple injuries; the mean Injury Severity Score was 41.2. Sixty-nine fractures were stabilized primarily within 8 hours after admission and 12 fractures were treated secondarily, in a mean of 5.8 days after injury. Closed intramedullary nailing was performed in 73 femora and open nailing with cerclage wiring was done in 8. All 81 nails were implanted unreamed and static was used in every case. The diameters of the nails used were 9 mm (n = 68) and 10 mm (n = 13). Proximal interlocking was distally directed in 76 cases and proximally directed in 5 cases. Two patients died of severe head injuries and one patient died of multiple organ failure. The infection rate was 0%, and uneventful consolidation of the fractures was seen in all cases within a mean of 3.8 months. Neither in the case of nails nor in the case of interlocking bolts did an implant failure occur.

[Immediate and late results following endarterectomy of the carotid bifurcation]. / Sofort- und Spätergebnisse nach Endarteriektomie der Karotisgabel.

In a retrospective study we analysed two groups each consisting of 100 consecutive patients of similar age and sex distribution who underwent surgery for carotid disease with an intervening period of 5 years (group A 1980/82, group B 1986/87) between the collectives. Against a background of changing indications, tactics and techniques the aim of the study was to detect any differences between the two groups. Group A had a higher proportion of coronary and peripheral vascular disease. The states of cerebral ischemia I, II and III were distributed equally, but state IV was seen more frequently in group B (p less than 0.05). The number of shunt/without shunt operations in group A was 97/2, in group B 10/84 (p less than 0.005). The external carotid artery was deobliterated in 58/81 cases group A versus group B (p less than 0.005). We closed the artery by direct suture in 8/31 (p less than 0.005), by autologous venous patch in 53/26 (p less than 0.005) and by Dacron patches in 39/41 patients. In group A the operative mortality was zero and in group B 1 patient died; one patient in group B developed sudden occlusion (with TIA) postoperatively. Transient intra-/postoperative neurological deficits occurred in 1/2, permanent in 4/2 patients (n.s.). 54/25 patients have died up to 31/08/91. Coronary heart disease was the main cause of late complications and deaths in group A (p less than 0.025). Statistically, there was no dependence of neurological deficits on group, sex, age or intraoperative management. Only patients with preoperative PRINDS hat a higher postoperative neurological deficit rate than the others.