Single hemicerclage for lateral type B malleolar fracture--a novel, minimal and reliable osteosynthesis.

AIM OF STUDY: To investigate the short- and long-term outcome of patients with isolated lateral malleolar fracture type B treated with a single hemicerclage out of metallic wire or PDS cord. METHODS: Over an 8-year period 97 patients were treated with a single hemicerclage for lateral malleolar fracture type B and 89 were amenable to a follow-up after mean 39 months, including interview, clinical examination and X-ray controls. RESULTS: The median operation time was 35 minutes (range 15-85 min). X-ray controls within the first two postoperative days revealed an anatomical restoration of the upper ankle joint in all but one patient. The complication rate was 8%: hematoma (2 patients), wound infection (2), Sudeck's dystrophy (2) and deep vein thrombosis (1). Full weight-bearing was tolerated at median 6.0 weeks (range 2-26 weeks). No secondary displacement, delayed union or consecutive arthrosis of the upper ankle joint was observed. All but one patient had restored symmetric joint mobility. Ninety-seven percent of patients were satisfied or very satisfied with the outcome. Following bone healing, hemicerclage removal was necessary in 19% of osteosyntheses with metallic wire and in none with PDS cord. CONCLUSION: The single hemicerclage is a novel, simple and reliable osteosynthesis technique for isolated lateral type B malleolar fractures and may be considered as an alternative to the osteosynthesis procedures currently in use.

[Value and use of pedal reconstruction in an extremity at risk for amputation]. / Sinn und Nutzen der pedalen Rekonstruktion bei der amputationsgefährdeten Extremität.

In patients with critical limb ischemia and patent pedal arteries as a single outflow source the surgeon has to decide between primary amputation and reconstruction. From 1989 to 1991 we performed 80 infrainguinal reconstructions, 13 of them to pedal arteries. In all cases we used autogenous vein material from different sources, if possible as an in situ conduit. The perioperative mortality was 0%. After 24 months the limb salvage was 92%. The secondary cumulative patency rate was 92% after 12, 74% after 24 months. In a selected group of patients we prefer arterial reconstruction to pedal arteries instead of a primary amputation.

[Villous adenoma of Vater's papilla. Problems in diagnosis and therapy]. / Das villöse Adenom der Papilla Vateri. Probleme in der Diagnostik und Therapie.

Adenomas of the ampulla of Vater are rare tumors which cause the same diagnostic problems as adenomas of the colon and rectum. From 1984 to 1991 we treated 5 patients with adenomas of the ampulla of Vater verified by endoscopy and biopsy. All 5 patients underwent transduodenal papillectomy and reimplantation of the common bile duct and pancreatic duct with intraoperative frozen section examination of the specimen. In 2 out of the 5 cases, the definitive diagnosis was invasive carcinoma undetected by frozen section examination. Both patients subsequently underwent partial duodenopancreatectomy with preservation of the pylorus. In one of our patients villous adenoma was detected six years after the insertion of a biliary endoprosthesis for alveolar echinococcus infiltrating the bifurcation of the hepatic ducts, a finding which raises the question as to an etiologic role of long-time biliary duct stenting. We discuss the diagnostic problems of the adenoma-carcinoma sequence and the therapeutic options.