[Injuries of the extremities and the locomotor system. Management in catastrophies].
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Biomedical subjects
Publications and source records attributed to E H Kuner.
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The psychological attitude towards the seat belt of 70 injured motor car passengers could be examined. The belt fastening rate was changed after the experience of having had an accident. Almost 80% of the questioned persons now always fasten their seat belt, whereas this is done only by 43% of the total collective. Although the usefulness of seat belts is not doubted by the majority of the questioned persons, almost 80% of them are afraid of difficulties concerning the loosening of seat belts.
Evaluation of more than 17,300 injuries caused by skiing in the Black Forest region between 1936 and 1980, shows that there has been a change in the pattern of injuries. However, the most frequent fracture occurring during skiing is, as it has always been, the fracture of the lower leg. Whereas ankle-joint fractures have receded, knee injuries have been increasing. This shows that the type of injuries to the leg have been undergoing a change as a result of modern skiing technique.
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From 1970 to 1978 61 patients with forearm fractures were treated by delayed osteosynthesis after primary conservative therapy. The reasons for this procedure are given. Therapy results of 96 adults with forearm fractures and primary osteosynthesis are better than those with a delayed operation, i.e. after four weeks or even longer.
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A case of a severe systemic anaphylactoid reaction is reported in a patient treated with dextran 60 to prevent venous thrombosis. Significant improvement of clinical symptoms occurred after the usual treatment of such incidents with corticosteroids, histamine H1 receptor antagonists, and plasma substitutes was supplemented with a histamine H2 receptor antagonist. We would therefore like to recommend that for such cases a histamine H2 receptor antagonist should be given in addition to the usual medication with corticosteroids and histamine H1 receptor antagonists. However, the value of complete histamine antagonism in these rather rare occurrences, can only be determined after furtherexperience has been gained.
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Vascular injuries were treated in 8 cases of total hip replacement. Acute and subacute arterial thrombosis, an AV fistula, and local thrombosis of pelvic veins were observed. These vascular complications of total hip replacement must be avoided by an effective local operative technique. Contact of bone cement with the vascular loge must also be avoided in order to prevent toxic or thermic irritation of arteries or veins.
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There is a high incidence of articular cartilage lesions together with other injuries of the knee joint. Single lesions are far more seldom. Difficulties in diagnosing cartilage lesions and the slow tendency toward recovery cause severe problems in treating this type of knee disorder. Elimination of enzymatic and mechanical interference and restoration of normal metabolic processes should be the therapeutic result. The plan of treatment depends on the pattern of the lesion. Conservative procedures or surgical intervention are possible methods of treatment. Both forms of therapy should avoid any immobilization of the knee joint whatsoever. Intraarticular injections are not indicated.