Compound fractures of the lower leg: clinical experiences and concept of treatment in multiple injury patients.

From 1980 to 1986 in 15 patients (16 lower leg fractures) with crush fractures of the lower limb, five had to be amputated primarily under emergency conditions, and four had successful reconstruction but required medical treatment for an average of one year. Seven secondary amputations were carried out because of infection of the bone, soft tissue and vascular occlusion. The level of amputation was at the proximal third of the tibia according to Dederich and Burgess. One leg was amputated 'through the knee'. The indication for amputation was based mainly on clinical findings, supplemented by bone X-rays, arteriography or arterial DSA. Doppler sonography was used for monitoring short intervals of blood flow in the emergency case unit, in cases of doubt.

[Humerus head resection as therapy of compound fracture of the upper arm--results]. / Humeruskopfresektion als Therapie bei Oberarmkopftrümmerfrakturen--Ergebnisse.

Proximal humeral fractures are frequent injuries in older patients. Most of these fractures respond satisfactorily to conservative treatment. Problems arise in cases of four-part displacements and in head-splitting fractures with massive defects in the articular surface. Between 1970 to 1988 eight patients were treated in our clinic in this situation by resection of the humeral head. 6 patients could be followed-up for an average of 69 months. Postoperative findings showed a restricted range of motion in all operated shoulders. The average abduction of the arm was 60 degrees (40-80 degrees) and elevation 60 degrees (40-80 degrees). The patients showed a mean external rotation of 17 degrees (5-30 degrees) and an internal rotation of 48 degrees (5-90 degrees). Only one patient was painless, 2 patients had pain during the night, and 3 patients suffered from various pain symptoms. Nevertheless 5 of 6 patients assessed the result as satisfactory and one patient as good.

[Perilunar dislocations and dislocation fractures in polytrauma patients--diagnosis and therapy]. / Perilunäre Luxationen und Luxationsfrakturen beim Polytraumatisierten--Diagnostik und Therapie.

Between 1978 and 1987 about 700 multiply injured patients were treated at the Department of Emergency Surgery (University Hospital Hamburg-Eppendorf). Seven of these suffered from injuries of the wrist, in detail six perilunar dislocations with fractures of the scaphoid and one dislocation of the triquetrum. In six cases the correct diagnosis was found primarily by clinical and X-ray examinations. The real extent of one patient's wrist injury was revealed by control radiograms which were taken twelve weeks after the accident, when the patient was transferred to our hospital. Follow-up examinations were made at an average of 40 months after the injury. We suggest the following procedure in cases of perilunar dislocations: 1. Early closed reduction and prolonged immobilization in casts. 2. In cases where closed reduction cannot be achieved open reduction, pinning (Kirschner-wires) and immobilization should be performed. 3. Fractures of the scaphoid are provided with screws.

[Surgical decompression of the fornix humeri, comparison of 2 procedures: resection of the ligament and Neer's method of anterior acromioplasty]. / Operative Dekompression am Fornix humeri, Vergleich zweier Verfahren: Ligamentresektion und vordere Akromionplastik nach Neer.

The impingement-syndrome is caused by a conflict between the humeral head, the rotator cuff and the coracoacromial arch. Degenerative changes in the rotator cuff appear to be the cause when conservative treatment fails, surgical decompression may be resorted to. The two methods commonly applied are the resection of the coracoacromial ligament and Neer's anterior acromioplasty. In this retrospective study 52 patients were followed up of whom 31 had ligament resection and 21 had acromioplasty. The average follow up time was 10 months. Excellent and good results were achieved by ligament resection in 16 patients (52%) and by acromioplasty in 12 patients (57%). Satisfactory results had 10 (32%) patients after ligament resection and 8 patients (38%) after acromioplasty. In 5 cases (16%) unsatisfactory results were achieved by ligament resection and in 1 case (5%) after acromioplasty. Statistically the results did not differ at the 5% level of error. Both methods retain the length of the acromion which is important as it is the attachment of the deltoid muscle and determines the functional lever arm of this muscle. The superior results of acromioplasty in cases with rotator tears suggest that this procedure could be beneficial as a routine decompression in these cases. Theoretically the acromioplasty creates more space for the reconstructed cuff.