[Surgical treatment of talus fractures].
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Biomedical subjects
Publications and source records attributed to G Hierholzer.
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Old aged people are more prone to accidents. This morbidity is caused by senile osteoporosis, preexisting diseases and other factors traumata. In most cases therapeutical problems of femoral neck fractures do not arise from surgery, but from general postoperative complications.
The conclusion from the above clinical and experimental presentation is that stabilization by using external fixation in problematic cases is the method of choice because the risk of infection is better than by using the standard methods of plating and nailing. Using external fixation based on the tubular system of ASIF we can achieve rigid stability. Correct application allows early mobilization ensuring alignment even in bone defects. This method of treatment also facilitates the care of wounds. Our experimental and clinical information provides us with the opportunity to offer a systematic classification of each individual type of external fixation and its merits, as described above in types I, II, and III and its application in different situations. Our clinical experience also shows that external fixation has greatly reduced the risk of amputation in these problematic cases, but it has not solved all the problems associated with the primary injury. The advantage of the three-dimensional external fixation type III can also be seen in the case of arthrodesis of the knee joint. Here there is a better neutralization of the bending moment, than by using type II. Finally we would like to emphasize that the external fixation is not the panacea for every problematic case and each surgeon should be well aware of its methodical and correct application, as abuse of external fixation may lead to secondary complications.
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The importance of capsular ligaments, in addition to the collateral ligaments and crucial ligaments, for stability of knee joint is accented. By systematic clinical examination the loss of stability and thereby the injured structures are determined with particular reference to rotatory instability by complex loss of stability. By sketches and tables, the examination procedure for the three topographic fields--medial system, lateral system, and crucial ligaments--is shown.
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The indications for external fixation with fixateurs externes are discussed and some important technical and biomechanical aspects are reviewed. The three-dimensional fixateur externe is recommended on the basis of clinical experimental research. Stability can be obtained with this even when bone defects and short metaphyseal fragments are present. The results observed after the treatment of aseptic and infected pseudarthroses of the tibia are shown in tabular form.
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