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ABSTRACT: EinleitungIm Rahmen eines distalen Speichenbruches können okkulte Bandverletzungen der Handwurzel auftreten. Die Inzidenz dieser Läsionen
wird in der Literatur sehr unterschiedlich angegeben (10% bis 75%). Die Inzidenz und Problematik der Diagnose dieser Läsion
wird anhand der retrospektiven Studie dargestellt
Patienten und methode45 konsekutive Fälle einer geschlossenen distalen Radiusfraktur bei 45 Patienten wurden durchschnittlich 4 Jahre nach Trauma
nachuntersucht. Zehn Patienten wurden operativ versorgt, bei den restlichen 35 erfolgte die konservative Behandlung durch
gedeckte Reposition und Gipsfixation für 4,5 (3 bis 8) Wochen. Alle Patienten wurden klinisch nachuntersucht, Standard-Röntgenvergleichsaufnahmen
beider Handgelenke wurden von drei unabhängigen Untersuchern evaluiert.
ErgebnisseBei vier Patienten konnte eine skapholunäre Dissoziation, definiert als eine skapholunäre Lücke von mindestens 2 mm im ap
Strahlengang und ein vergrößerter skapholunärer Winkel über 60° in der seitlichen Aufnahme festgestellt werden. In weiteren
zwei Fällen lag eine chronische beidseitige skapholunäre Instabilität vor — diese Patienten waren jedoch klinisch beschwerdefrei.
Alle Patienten mit einer posttraumatischen skapholunären Dissoziation zeigten eine signifikant eingeschränkte Radial-Ulnarabduktion
im Vergleich zur unverletzten Extremität oder zur Gruppe der Patienten ohne begleitende karpale Bandläsion. Drei Patienten
klagten über leichten Ruheschmerz, alle vier Patienten gaben leichten bis mäßigen Belastungsschmerz an.
DiskussionAlle Fälle mit der skapholunären Dissoziation blieben bei der Erstuntersuchung und im Laufe der Routineuntersuchungen unentdeckt
und somit primär inadäquat versorgt. Anhand der klinischen Ergebnisse dieser Studie und der Literaturangaben wird die Problematik
der okkulten skapholunären Dissoziation dargestellt.
IntroductionThe aim of this study was to investigate the clinical consequences of scapholunate dissociation associated with fractures
of the distal radius and the impact on wrist function. Fractures of the distal radius and scapholunate dissociation overlap
in pathomechanics. The diagnosis however is frequently missed initially.
Patients and methodsWe reviewed 45 consecutive patients with closed distal radius fractures with a mean follow up of 48 months. Ten patients underwent
surgery and 35 patients were treated by fracture reduction and cast immobilization during 4.5 (range 3 to 8) weeks. All patients
were re-examined clinically and radiographs of both wrists were compared.
ResultsFour patients showed evidence of SLD in the scapholunate joint region based on specific criteria (scapholunate gaps > 2mm
on anterior-posterior radiograph and the scapholunate angle >60° on lateral radiograph). All patients with SLD showed a poor
radioulnar deviation. Three patients reported mild to moderate pain.
DiscussionThe difficulties in management of SLD may be avoided by early detection and treatment. In all investigated patients the diagnosis
was missed after the initial trauma. Untreated SLD can lead to carpal collapse and arthrosis of the wrist, and ultimately
to scapholunate advanced collapse.
Wiener klinische Wochenschrift 04/2012; 115(15):580-583. · 0.81 Impact Factor
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ABSTRACT: In Austria, treatment of multiple trauma patients has developed into an established nationwide trauma center specialty with its own unique identity. Although it represents a substantial financial investment, it ensures supply at international standards. The question of whether multiple trauma patients should be treated only in specialized trauma centers or in several hospitals remains controversial on both national and international grounds. The aim of this study was to assess Austrian trauma departments for international comparison.
We performed a survey of all 54 Austrian trauma departments by collecting data through questionnaires. The number of staff, potential of infrastructure, and treatment strategies were obtained.
93.3% of the trauma departments responded to the questionnaires. In level I trauma centers the amount of trauma beds reached 11% of the total bed capacity, 13% in level II, and 18% in level III units. Level I centers showed an average of 35% of intensive care beds for trauma patients. 53% and 51% were the proportions for level II and III centers. Level I hospitals displayed an average of 28.3 trauma surgeons, while level II and III units had less doctors at their disposal in the trauma departments. On average, 94% of the patients arrived by emergency medical support at the hospital. 94% of the trauma departments used chest tubes, 70% performed craniotomies and neurovascular reconstruction. 33% of the centers were equipped to perform replantations.
The data demonstrate the broad spectrum of polytrauma treatment in Austrian trauma centers. The discussed need for centralization of polytrauma care cannot be justified based on these data. Limiting from a medical perspective, however, is the lacking comparability of quality of care due to the currently missing objective quality criteria.
Wiener klinische Wochenschrift 12/2011; 124(3-4):78-84. · 0.81 Impact Factor
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ABSTRACT: Despite clinical efforts to treat growth disturbances only little is known about the growth potential of the different zones of the growth plate. The aim of this study was to investigate the growth potential of different zones of the growth plate. A total of 20 New Zealand White rabbits were used for this experiment. The right and left ulna of each animal were used resulting in a total of 40 ulnae. Animals were assigned into five groups. In groups I and II resection of the metaphyseal (n = 12) or the epiphyseal (n = 6) segment of the growth plate was performed. In group III resection of the growth plate and re-implantation was performed (n = 6). In group IV the growth plate was resected and re-implanted after a 180° rotation (n = 6). Animals in group V served as controls. Histologic and radiologic examinations were performed to evaluate the growth process at 1, 2, 4, and 12 weeks following surgery. In group I, III, and IV temporary growth disturbance which was compensated within a short time was observed. Resection of the epiphyseal part resulted in growth arrest of the distal ulna in combination with normal growth of the radius which led to and valgus deformity of the limb. The results of this study indicate the importance of the reserve zone for the functioning of the growth plate.
Journal of Orthopaedic Research 07/2011; 30(1):162-8. · 2.81 Impact Factor
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ABSTRACT: Fractures of the head and neck of the femur in children are very rare, occurring only after a high-velocity trauma, e.g. a fall from a height. This analysis shows the clinical course of traumatic femoral head and neck fractures in paediatric patients. Predisposing factors for poor outcome or fracture complications, such as non-union or femoral head necrosis, are described. Between 1993 and 2006, 16 paediatric patients with proximal femoral fractures were treated at the Level One Trauma Centre of the Medical University of Vienna. The minimum follow-up was two years. Inclusion criteria were age less then 16 years, intact growth plate and a proximal femoral fracture according to the classification by Delbet and Colonna. Exclusion criteria were pathological fractures or fractures of the subtrochanteric region (6/16). Ten patients met the inclusion criteria. Two patients were lost to follow-up. Therefore eight patients were included in the study. All patients except one were operated upon within 48 h after the injury ("primary") and healed without further complications. A single case was managed by "secondary" surgical treatment, two weeks after the initial trauma resulting in femoral head necrosis that healed without any subjective complaints. This case series confirms the importance of early surgical fixation of proximal femoral fractures in paediatric patients. An operative intervention later then 48 h after the initial trauma may increase the risk of complications such as femoral head necrosis, particularly in Delbet type I fractures (traumatic slipped capital femoral epiphysis).
International Orthopaedics 06/2011; 35(6):883-8. · 2.03 Impact Factor
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ABSTRACT: Injury of the growth plate is a specific problem in traumatology and can cause limb deformity and length discrepancy as a result of growth arrest. The purpose of this study was to evaluate alterations of the growth plate after artificially created injuries. A total of 14 New Zealand White rabbits were used for this experiment. The right and left ulna of each animal was used resulting in a total of 28 ulnae. In six animals drill holes were driven into the growth plate either from the distal/epiphyseal side or from the proximal/metaphyseal side of the physis. In six animals a fracture of the distal ulna corresponding to a Salter-Harris fracture type IV was created. This fracture was fixed by screws from either the epiphyseal or the metaphyseal side. Two animals served as controls. Histologic and radiologic examinations were performed to evaluate the growth process at 1, 2, 4, and 12 weeks following surgery. Drilling or fixation of the growth plate from the metaphyseal side resulted in temporary growth disturbance which was compensated within a short time. In contrast fixation from the epiphyseal side caused severe growth disturbances. Based on our findings K-wires or screws should be inserted from the metaphyseal side and be placed in the center of the growth plate.
Journal of Orthopaedic Research 05/2011; 29(12):1834-9. · 2.81 Impact Factor
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ABSTRACT: The aim of this study was to investigate the clinical consequences of scapholunate dissociation associated with fractures of the distal radius and the impact on wrist function. Fractures of the distal radius and scapholunate dissociation overlap in pathomechanics. The diagnosis however is frequently missed initially.
We reviewed 45 consecutive patients with closed distal radius fractures with a mean follow up of 48 months. Ten patients underwent surgery and 35 patients were treated by fracture reduction and cast immobilization during 4.5 (range 3 to 8) weeks. All patients were re-examined clinically and radiographs of both wrists were compared.
Four patients showed evidence of SLD in the scapholunate joint region based on specific criteria (scapholunate gaps > 2 mm on anterior-posterior radiograph and the scapholunate angle > 60 degrees on lateral radiograph). All patients with SLD showed a poor radioulnar deviation. Three patients reported mild to moderate pain.
The difficulties in management of SLD may be avoided by early detection and treatment. In all investigated patients the diagnosis was missed after the initial trauma. Untreated SLD can lead to carpal collapse and arthrosis of the wrist, and ultimately to scapholunate advanced collapse.
Wiener klinische Wochenschrift 09/2003; 115(15-16):580-3. · 0.81 Impact Factor
