[Fragment dislocation and surgical indications in segmental fractures of the radial head]

The aim of this study was to evaluate the influence of primary displacement of fragments of the radial head on the clinical result after conservative therapy, also to see whether the extent of displacement could give valuable indications for operation. In non-displaced fractures the results are slightly but significantly better than in displaced fractures. On the other hand, the amount of displacement must be considered to be of minor importance. In 64 percent of conservatively treated patients the results were good despite displacement and the results were similar after primary open reduction. It has to be assumed that undiagnosed lesions of the joint capsule and ligaments are the most important cause of residual functional deficits.

[Failures of clavicular intramedullary wire fixation and their causes]

The fixation of fractures of the clavicle by intramedullary Kirschner wires is a semirigid method. External fixation of the arm after operation is, therefore, necessary. 25 out of 38 fresh fractures in our series healed in ideal position of the fragments. Another eight fragments healed under angulation of 10 degrees to 35 degrees. Five patients developed pseudarthrosis, three of whom had multiple fragmentation. Only two of a total of eight multiple fractures healed in good position. The causes for negative results are multiple fragmentation or technically insufficient fixation--mainly perforation of the corticalis of the medial fragment by the wire and therefore improper position of fragments and K-wires or too short intramedullary run of the wire in the medial fragment. Wires of less than 2.0 mm in diameter are not strong enough to withstand the bending forces. The intramedullary wire fixation gives adequate results in transverse or short oblique fractures of the middle third of the clavicle if good reposition is obtained and if the thickest possible wire or, better, two wires are introduced. In all other cases and especially in multiple fragmentation higher stability has to be achieved by plate fixation.

[Conservative therapy of isolated radius head fracture--immobilization or early functional movement treatment?]

We reviewed 95 patients with isolated fractures of the radial head. 33 of them were treated by plaster cast fixation for three weeks, 62 by immediate active motion. No difference in frequency of arthrosis and periarticular ossification in both groups could be observed. Examination of the patients two to four years after trauma showed excellent functional results in 61% of the 33 patients and in 77% of the 62 patients. The average duration of treatment is shorter by two weeks in the group of immediate active motion. The clinical results of this group, although not statistically significant, seem to be better than after immobilization.

[Treatment and results in acute pyogenic arthritis]

Pyogenic arthritis poses a serious complication to the opening of a joint. In the past eight years we have treated 22 patients suffering from acute infection of the knee joint and the talo-crural joint. Cases with infection of osseous origin were excluded. Infection was mainly caused by contamination during ligament reconstruction. Our therapy consisted of emergency operative revision of the joint, removal of necrotic tissue, and installation of an irrigation-suction-drainage system. The joints were immobilized and systemic antibiotics were administered in all cases. In four cases the installation of the irrigation-suction-drainage system in the knee joint was performed percutaneously without opening the joint. Of these, three had to be reoperated as the infection could not be controlled. During recent years we preferred to use a 0.5% PVP-I-solution for irrigation, because of the antiseptic effect. Irrigation treatment is limited to a period of seven days. Two out of 15 cases of knee-joint infection and three cases out of seven of talo-crural-joint infection resulted in ankylosis. In cases in which treatment began in the first week after contamination almost all had excellent clinical results. Substantial previous damage to the joint or delayed treatment usually prevented complete restoration of the joint's function.

[Incidence of open fractures in children (author's transl)]

In nine years 8144 cases of fractures in children were treated in Lorenz Böhler Accident Hospital in Vienna. 5.3% of these were fresh open fractures, more than half of which were of the thumb and fingers, with a large proportion of open fingertip fractures. These were followed by, in order of frequency, forearm fractures, skull fractures and tibia fractures. On average, 63% of the patients were boys, the percentage increasing, however, with age. Pre-school children constituted about half as many of the patients as children of school age. Traffic accidents, mainly those involving pedestrian children, caused three times as many open fractures as closed fractures. The figures given are compared with the number of closed fractures.

[Wound cleansing with the enzyme combination fibrinolysin/deoxy-ribonuclease]

This clinical investigation was performed to evaluate the therapeutic efficacy of enzymatic wound débridement. Fibrolan (Elase), a combination of fibrinolysin and desoxyribonuclease, was administered in 42 patients with infected accidental or operation wounds. After a treatment over 12 to 14 days all but two wounds showed clean granulation tissue and secondary wound closure could be achieved. There was no sign of adverse drug reaction. A recommendation of this method in the treatment of infected wounds can be given.

[The lag screw fixation of medial femoral neck fractures (author's transl)]

The lag screw osteosynthesis of medial femoral neck fractures is a straightforward procedure with little danger of complications. A conclusion may be drawn from the results of several authors that this method may even have a favourable influence in reducing the frequency of pseudarthrosis. In order to come to a final conclusion, however, the results of large treatment programmes would have to be studied. Fractures which are technically accurately treated allow probably full weight bearing. Lag screw osteosynthesis using more than 2 spongiosa screws in a parallel position has proved, both theoretically and practically, to be a useful method of treatment. The caudal screws increase the stability due to their position on the caudal rim of the femoral neck, while the cranial screws ensure against rotation and exertion of tensile force.

[The experimental measurement of torque and axial force of 6.5 mm ASIF lag screws in fixation of femoral neck fractures (author's transl)]

An experimental study was undertaken to evaluate the torque and axial force of the 6.5 mm ASIF lag screw implanted in the femoral neck after a subcapital osteotomy. The experiments were carried out on autopsied bones of more than 60 years of age. The average torque was 204 cmN, the screws in the upper half of the femoral head showing a higher torque than those in the lower half. The axial tension was measured by strain gauge transducer. Depending on the length of the thread of the screw (16 or 32 mm) the average tension reaches 1162 N or 1960 N. By tightening the screw until the impression of optimum fit is obtained, 70% of the maximum axial force is reached. It can therefore be estimated that at the beginning an interfragmentary pressure of 4000 to 8000 N is exerted on a medial femoral neck fracture fixed by four ASIF lag screws.

[Venous thromboses and pulmonary emboli in autopsy material (author's transl)]

Venous thromboses of the pelvic veins and the veins of the lower limbs were found in 40% of the post mortems carried out on 1350 adults during 1974. The thromboses were bilaterally located in the calf veins in the vast majority of cases. The predominating underlying diseases of patients with thrombosis were malignant neoplasia or cardiovascular diseases. 319 cases (23.5%) showed massive pulmonary embolism. The pulmonary embolism had taken a fulminating fatal course in 7.8% of cases. Thromboses of the lower limb veins seem to have a higher tendency to become mobilized to cause fatal pulmonary embolism than thromboses occurring in other sites. A significantly higher incidence of venous thrombosis, as well as of pulmonary embolism, was found in higher age groups and in female patients; the prognosis is, moreover, grave in these cases. A significant increase in the incidence of venous thromboses and pulmonary embolism-especially those with a rapidly fatal course-has been registered over the past years as compared with previous investigations.