[Fat embolism syndrome following lower limb fracture despite rapid external fixation. Two case reports and review of the literature]. / Fettemboliesyndrom nach Unterschenkelfraktur trotz sofortiger Versorgung mit einem Fixateur externe. Zwei Kasuistiken und Literaturübersicht.

Fat embolism syndrome (FES) is a rare complication occurring in 0.9-2.2% of patients following long bone fractures. Patients present with a classical triad of respiratory manifestations, cerebral effects and petechiae. The incidence of FES is reduced by early immobilization of fractures and by minimally invasive operative management. Nevertheless, two healthy young men suffered from FES after immediate (within 3 h after trauma) external fixation of lower leg fractures. This postoperative complication should always be considered even after conservative or minimally invasive therapy.

[Intestinal perforation following blunt abdominal trauma in patients with pre-existing inguinal hernia]. / Dünndarmruptur nach stumpfem Abdominaltrauma bei vorbestehender Inguinalhernie.

BACKGROUND: Intestinal perforation following blunt trauma to the abdomen is a rare but life-threatening complication in patients with pre-existing inguinal hernia. MATERIAL AND METHODS: We examined retrospective case series of patients with intestinal perforation following blunt abdominal trauma. RESULTS: Within 2 years, three patients with pre-existing inguinal hernia were referred to our clinic following simple falls while cross-country skiing. Upon signs of abdominal tenderness and radiographic evidence of free air, explorative laparotomy with revision of the affected bowel segments was performed. The postoperative course was uneventful in two patients. One developed adhesive ileus and incisional hernia within 1 year. CONCLUSIONS: Intestinal perforation must be suspected in patients with inguinal hernia and signs of diffuse abdominal tenderness following blunt trauma. Urgent explorative laparotomy with revision of the affected bowel segments is mandatory in patients with free abdominal air. Secondary hernia repair may represent the safest and most reliable approach and should be delayed until full recovery from the initial surgery.

[Femoral neck fracture and femoral head necrosis]. / Schenkelhalsfraktur und Femurkopfnekrose.

In this study we wanted to demonstrate the relationship between the fracture of the femoral neck and femoral head necrosis. For this purpose we reviewed the new literature, the dates of the ASIF documentation and some cases from the Davos Hospital. Head necrosis appears in all types of fractures and is independent of the implant. We can find femoral head necrosis in all age groups but the risk is higher the younger the patient. The necrosis can develop many years after the accident. There are not enough long-term studies to explain this phenomenon.

[Meniscus ultrasound--a reliable way for diagnosis of meniscus lesions?]. / Meniskus-Sonographie--ein sicherer Weg zur Diagnose von Meniskusläsionen?

Controversies exists about the value of sosgraphy in diagnosis of meniscal injuries. We therefore examined 179 knee joints. In a prospective study of 177 patients with knee problems, ultrasound was utilized to assess its values as a screening tool for meniscal tears. Prior to the arthroscopy the menisci were scanned from an independent team by using 7.5 and 10.0 MHz ultra-sound waves. 113 meniscal tears were seen at arthroscopy; 22% of these tears could not be detected by scanning (false negative results) while 10% of intact menisci showed positive echogenic structures analysed as meniscal tears. The results showed a sensitivity of 30.0% and a specificity of 85.3%. We cannot share the opinion of some autors that ultrasound is a reliable means of accurately diagnosing meniscal tears. It seems that ultrasound scanning of the menisci is still a experimental method without any clinical importance.

[Snow board accidents. Multicenter Swiss snow board study 1992/93 with the cooperation of the bfu]. / Snowboardunfälle. Multizentrische schweizerische Snowboardstudie 1992/93 unter Mitwirkung der bfu.

Snowboarding has become increasingly popular in recent years. A prospective multicenter study was therefore performed during the winter 1992/93. 345 injuries were analysed and compared with 305 healthy snowboarders on the slopes. Preliminary results show predominantly injuries of the upper extremity comparative to those suffered from alpine skiing. Protection of the hand and wrist is recommended as well as an instruction for a special technique for falling as measurements for accident prevention.

[Injuries in snowboarding]. / Verletzungen beim Snowboarding.

Snowboarding is a quickly developing wintersport. The estimated number of snowboarders in Switzerland lies between 20,000 and 30,000 now. There has not been much published about trauma in this sport. This study was carried out in five Swiss hospitals in the winters 1988/89 and 1989/90. The results were compared with the data of a traumatologically oriented general practice. The pattern of trauma was almost identic, and quite similar to the injuries in skisport. With further development of the snowboard technique and material a change of type and decrease of number of injuries in this sport can be expected.