[Cervical spine injuries in stable lower cervical spine with spinal stenosis]. / Zervikale Rückenmarkverletzungen bei stabiler unterer Halswirbelsäule mit Spinalkanalstenose.

The aim of the study was to investigate the neurological outcome of spinal cord injuries in the traumatized cervical spine with a stenosis of the spinal medullary canal. From 1992 to 1999 we treated 145 spinal cord injuries and/or injuries with an unstable cervical spine, 138 were treated operatively, in 7 patients we found an injury of the spinal cord with a stable cervical spine and a stenosis of the spinal medullary canal. The radiological diagnostics consisted of anterioposterior X-rays of the cervical spine, an X-ray view of the dens axis and a stress roentgenogramm in extension and flection. An MRI was performed within the first 12 hours after the accident. The stenosis of the spinal medullary canal was evaluated by the quotient of the mid-sagittal diameter of the spinal medullary canal as well as the vertebral body (Torg-quotient) and ranged from 0.5 to 0.8. Pathological changed values were found in 4 patients within 2 segments and in 3 patients within 3 segments. In the T2-turbospin echo sequence hyperintense lesions of the spinal cord, accordingly to an edema were found in 6 patients. The neurological evaluation was performed according to the "Standard Neurological Classification of Spinal Cord Injuries". Treatment of these 7 patients was performed conservatively, consisting of NSAR as well as Methyl-Prednisolon according to the pattern of NASCIS-II and III. The follow-up was performed after 12 to 18 months. We evaluated the X-rays in anterioposterior and lateral view, stress roentgenogramms and neurological status. Radiological findings showed stable conditions of the cervical spine with block vertebras and increased osteophytes. The neurological outcome was evaluated according to the "Motor-Score" and showed an improvement from 8 to 63 points within 13 months in one case. In 6 cases, the average "Motor-Score" of 78 increased to 100 points within 2 to 5 months after injury. Most defunctionalization symptoms were found in the upper extremities. Disturbances in fine motor movement were unable to be examined with the "Motor-Score". We can conclude that spinal cord injuries in stable cervical spines with stenosis of the spinal medullary canal can be treated conservatively with a good outcome. A regression of the neurological deficiency can be expected within 2 to 5 months, but even after one year, deficiency regression is possible.

[First experiences with unreamed AO intramedullary nail in treatment of femoral shaft fractures]. / Erste Erfahrungen mit dem unaufgebohrten AO-Marknagel (UFN) in der Behandlung von Oberschenkelfrakturen.

The unreamed femoral nail (UFN) system, with its numerous proximal interlocking options, allows a minimal invasive surgical procedure for the treatment of nearly all femoral fracture patterns. Sixty-six fractures, 5 cases of osteolysis or pathologic fractures, 2 limb shortenings and 1 lengthening (monorail technique) and 3 cases of pseudarthrosis were stabilised with the UFN from July 1994 to December 1996. The fractures were analysed according to the AO classification. We found 31 polytrauma patients with an mean ISS of 21.8 and a mean PTS of 25.4. Most of the multiply injured patients (n = 26) were stabilised with the UFN primarily. Follow-up of 44 patients ranged from 4 to 18 months postoperatively. According to our clinical and radiological score the results were excellent in 34% of cases, good in 36.3%, poor in 20.4% and bad in 9%. Average fracture healing time was about 9.8 weeks.

[The UFN-system (unreamed femoral nail)--avoidable intra- and postoperative complications]. / Das UFN-System--Vermeidbare intra- und postoperative Komplikationen.

We give an account of the first Austrian clinical results of a prospective study dealing with fractures of the femoral shaft treated with the UFN-system, the intraoperative handling especially considering the intra- and postoperative complications. The UFN-system combines the advantages of numerous proximal interlocking options for the treatment of nearly all femoral fracture patterns with that of the unreamed nailing (biological osteosynthesis, primary stability with individual after-treatment, high patient's comfort and early mobilisation). Within two years (VII/94-VII/96) sixty closed and four second degree open fractures were stabilized with the unreamed femoral nail. In twelve cases we used the spiral blade interlocking technique. Five times we changed from external fixator to the UFN. The fractures were classified according to the AO-classification. In 64 implanted UFN there occurred twelve intraoperative and four postoperative complications. In five cases reoperation was necessary. Failings in the operative technique, numerous different experienced surgeons and a deficient after_treatment led to our pitfalls.

Unstable fractures of the upper thoracic spine.

Unstable fractures of the upper thoracic spine are a therapeutic challenge because of the high rate of associated injuries and frequent occurrence of spinal cord lesions. This study focuses on the operative treatment of these injuries. We present nine patients with unstable injuries of the upper thoracic spine. According to the classification of Magerl et al., there are seven type C and two type B fractures. Eight patients had complete transverse lesions of the cord and one had no evidence of spinal cord injury. All patients presented associated injuries: nine patients had fractured ribs, three a fractured sternum and three a severe haemothorax. All underwent operative treatment: six posterior fusions only, two anterior interbody fusions only after thoractotomy owing to severe bleeding from ruptured intercostal arteries, and one a combined fusion after failure of posterior fusion. The treatment of these patients should be individualized, depending on the associated injuries, loss of blood owing to fractured spine and ruptured vessels and depending on the back pain resulting from an unstable thorax. In general, we prefer the posterior approach to unstable fractures of the upper thoracic spine.

[UFN system. A method of minimal invasive surgical management of femoral shaft fractures]. / UFN-System. Eine Methode der minimalinvasiven chirurgischen Versorgung von Oberschenkelschaftfrakturen.

The aim of this study is to present our early clinical experience using the Unreamed AO Femoral Nail (UFN). The UFN system combines the advantages of numerous proximal interlocking options for the treatment of nearly all femoral fractures patterns with those of unreamed nailing (biological osteosynthesis, preservation of the cortical blood supply, closed mediate reduction, primary stability, high degree of patient comfort). Operation time and blood loss are reduced by eliminating the reaming procedure. The risk of infection is minimized by avoiding dead space. The positioning of the patient on the operating table without the use of traction allows for a minimally invasive surgical procedure. Our report deals with intraoperative handling, intra- and postoperative complications and the prospective clinical outcome in using the solid femoral nail system in Austria. Within nearly 2 years (August 1994-April 1996) 52 closed fractures and four second-degree open fractures were stabilized using the unreamed femoral nail. In 12 cases we used the spiral blade interlocking technique. Four times we changed from external fixation to the UFN. According to the AO classification, we found 8 fractures of the proximal femur (A 1/1: 1; A3/1: 2; A3/3: 5) and 48 diaphyseal fractures (A1:4; A2: 7; A3: 16; B1: 5; B2: 6; B3: 6; C1: 1; C2: 2; C3: 1). Thirty patients were followed up over an average period of 9.1 months postoperatively. The clinical and radiological results were excellent in 20 cases; average fracture healing time was about 10.6 weeks.

[Hyperextension injury of the lower cervical spine and diagnosis of dorsal unstable motion segments]. / Hyperextensionsverletzung der unteren Halswirbelsäule und die Diagnostik von dorsal instabilen Bewegungssegmenten.

Five patients with hyperextension injuries and dorsally instable motion segments are presented. In the diagnosis of posterior instabilities plain roentgenograms demonstrated no characteristic signs of an injured cervical spine. Flexion and extension views detected a mild degree (2 mm) of retrospondylolisthesis in four cases and a widened disc space in one case. In all five patients the MR findings that made use suspect a posterior unstable motion segment were disc protrusions; in addition, in two patients these was hemorrhage in the spinal cord and in one patient cord edema.

[Diagnosis, therapy and prognosis of Pipkin fractures (femur head dislocation fractures)]. / Diagnostik, Therapie und Prognose der Pipkin-Frakturen (Femurkopf-Verrenkungsbrüche).

Fractures of the femoral head combined with a dislocation of the hip are rare injuries. In the period from 1975 to 1993 nine of our 231 operatively treated patients who had a hip injury sustained a Pipkin fracture. According to the history of our patients and the results of the last 18 years we discuss the possibilities of diagnosis, treatment and prognosis of the fracture of the femoral head with dislocation of the hip.

[Computerized sonometry--use of a noninvasive procedure for evaluating stability after fractures]. / Computerisierte Sonometrie--die Anwendung eines nicht-invasiven Verfahrens zur Stabilitätsbeurteilung nach Frakturen.

Common techniques to assess the healing process of fractures are usually related to the experience of the clinician. However, standard x-rays allow only indirect conclusions on the stability of the healing bone. In addition to the radiological examination delayed union or non-union can only be diagnosed in the absence of specific changes such as callus formation. Computerised sonometry comprises the analysis of mechanical vibration as well as sound transmission during or after bone healing. This non-invasive method allows for assessing the stiffness of the bone quantitatively and gives objective data on bone stability.

[Experience with plating of intra-articular fractures of the calcaneus]. / Erfahrungen mit der Verplattung von Fersenbeinimpressionsfrakturen.

There have been various attempts to improve the results of treatment of fractures of the calcaneus in recent decades. Descriptions of conservative treatment with plaster cast, functional treatment and several methods of closed and open reduction and stabilization have been published. We believe that, especially in young patients, intraarticular fractures with depression of the posterior articular facet should be treated by open anatomical reduction, autologous bone grafting and stabilization with plates. In our clinic 15 fractures of the calcaneus have been treated in this manner in the last few years, and the results are very satisfying.