[Femoral neck fractures in bicyclists due to clipless pedals]. / Collum femoris-fractuur bij fietsers door 'clipless' pedalen.

Femoral neck fractures in healthy young adults caused by a relatively low-energy trauma are uncommon. The cases are presented of four cyclists, men of 37, 42 (n = 2) and 43 years old, with a femoral neck fracture, in which so called clipless pedals played an important part. The shoes of the cyclist are affixed to these pedals, and the patients had been unable to remove their feet quickly when they fell. They were treated by osteosynthesis using screws, but one of them developed intra-articular infection which eventually necessitated implantation of a total hip prosthesis.

Is early osteosynthesis safe in multiple trauma patients with severe thoracic trauma and pulmonary contusion?

The timing of osteosynthesis of major fractures in patients with multiple injuries is still disputed. Recently questions have been raised as to the possible detrimental effects of this treatment on pulmonary function in patients who have additional thoracic trauma. In this study the charts of 57 consecutive patients with multiple injuries including thoracic trauma were analyzed. Thirty patients without major fractures were compared with 27 patients with major fractures treated by early osteosynthesis. Despite a significantly higher Injury Severity Score (ISS) in in the group with major fractures, there was no significant difference in pulmonary function between the two groups. We conclude that the presence of thoracic trauma should not be regarded as a contraindication for early surgical stabilization of major fractures.

Femoral shaft fractures treated with plate fixation and interlocked nailing: a comparative retrospective study.

UNLABELLED: In a retrospective study, the results of 39 patients with fresh unilateral femoral shaft fractures were studied: 19 had been treated with an AO interlocking nail and 20 with an AO plate. The preoperative characteristics of both groups were similar. The interlocking nail procedure took significantly longer (P = 0.002, Wilcoxon's test) and was associated with technical faults in seven patients. Full weight-bearing was allowed significantly earlier (P = 0.001, Wilcoxon's) in the interlocking nail group. Delayed union was observed in three patients in the plate osteosynthesis group but was not encountered in the interlocking nail group. Cancellous autogenous bone grafting was performed seven times during or after plating, but was not necessary in the interlocking nail group. Two cases of osteitis arose after plating and none after interlocked nailing. At follow-up, one patient in each group was suffering from serious complaints. CONCLUSION: The interlocking nail procedure took longer than plating, but allowed earlier full weight-bearing. The final results were similar in both groups of patients.

[Extra-long plate osteosynthesis in femoral fractures]. / Extralange Plattenosteosynthese bei Femurfrakturen.

Of 252 femoral shaft fractures seen within a 9-year period, 32 (13%) were treated by internal fixation with an extra long DC plate, mainly because of severe comminution or fractures at two or more levels. Depending on the localization of the fracture, extra long, straight or angled plates were used. Half of the 32 patients showed multiple other injuries (mean ISS 39). Delayed union was seen in 4 patients, necessitating repeat osteosynthesis in 2. Postoperative osteitis was seen in 1 patient. The average time for consolidation was 22 weeks (10-50 weeks). The mean duration of hospitalization was 31 days. Apart from specific complications resulting from other severe injuries in 2 patients, the overall functional results were good.

Small-bowel perforation complicating the open treatment of generalized peritonitis.

Fourteen patients were found to have developed 53 small-bowel perforations in the absence of pathogenic factors during "open abdominal treatment" for generalized peritonitis. They occurred after three to 17 laparotomies, on average at the eighth postoperative day (one to 120 days). Forty-nine lesions were located superficially. A relation with organ system failure, routine blood tests, type of nutrition, or microorganisms could not be demonstrated. The etiology of the lesions remains uncertain, but the open abdominal treatment must play some important role in its pathophysiology. Five patients survived. The therapy of choice appears to be mobilization of the bowel with resection of the affected part and primary anastomosis.

Acute diaphragmatic rupture due to blunt trauma: a retrospective analysis.

Twenty-eight cases of diaphragmatic rupture due to blunt trauma are reviewed. The need for accurate and rapid diagnosis and results of treatment are discussed. Chest roentgenogram was found to be the best diagnostic aid. Surgical repair through an abdominal approach is advised in all acute cases. The high mortality rate in this series (28.6%) is related to the multiple injuries rather than to the diaphragmatic lesion itself.

Duration of fracture healing after early versus delayed internal fixation of fractures of the femoral shaft.

The effect of delayed internal fixation in closed uncomplicated fractures of the femoral shaft was studied by comparing 40 patients from a hospital where this fracture was principally treated within 24 hours of the injury, with 46 patients from another hospital where this type of fracture was principally treated after a mean period of 13 days in skeletal traction. The two groups of patients were similar with regard to age, level of fracture, type of fracture and incidence of comminution. All fractures were treated by stable internal fixation. In the group treated by early operation considerably longer AO plates were used. Although delayed fixation resulted in more callus and although secondary bone healing was more frequent than in the group with early internal fixation, no difference in the rate of union of the fractures could be demonstrated.

Thyroid cancer mimicking thyroiditis.

Two patients with thyroid cancer, who presented with clinical and biochemical features of subacute thyroiditis, are reported, Confusion in diagnosis delayed therapy from 3 to 8 months. The relation between thyroiditis and thyroid cancer is discussed.

Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient.

Prophylactic mechanical ventilation with PEEP of patients with severe injuries prevents or attenuates the clinical manifestations of ARDS. Also, operative stabilization of all major fractures appears to be beneficial in reducing the incidence of ARDS. Primary external or internal fixation of all unstable long-bone fractures combined with prophylactic ventilation is safe and well tolerated, and allows for optimal nursing of the patient. In a group of 58 severely injured patients, treated accordingly to these principles, late death from remote organ failure due to sepsis--which is the main cause of death in multitrauma patients treated with delayed osteosynthesis or conservative fracture treatment--did not occur. Prophylactic mechanical ventilation with PEEP resulted in a significantly lower incidence of ARDS.