["Stable" fracture of the ulna shaft. Biomechanics and therapeutic consequences].
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Biomedical subjects
Publications and source records attributed to G Muhr.
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One of the most neglected lesions are spinal fractures for which early diagnosis is essential. Deviation of the spinal axis must be avoided during emergency treatment and transport. X-ray diagnosis must focus on the injured segment, and indirect radiological signs are also important. A CT-scan is the optimal means of early diagnosis. Emergency reduction is indicated in cases of neurological deficit and severe kyphosis. In such cases reduction means decompression.
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Post-traumatic infection of the elbow joint is a serious complication, because the bone structure and the thin soft tissue cover make all actions directed at reconstruction and at calming the infection difficult. A good overall prognosis for later function depends decisively on early diagnosis, stability of the fragments and the earliest possible initiation of functional therapy. If this cannot be achieved, the infection must first be treated by transfixation techniques and the joint function restored subsequently. In late cases with chronic inflammation and destruction, nothing but resection arthroplasty or arthrodesis is still possible.
The meniscus acts as a shock absorber and resists against sagittal and rotational forces. The function is similar to the anterior cruciate ligament. The function of the meniscus is similar to that of the anterior cruciate ligament, ruptures of the ligament are often connected with meniscal tears. In cases of insufficiency of the anterior cruciate ligament, the meniscus guarantees a certain stability. Therefore the aim of the meniscal surgery today is to preserve as much meniscus function as possible.
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Polylactide-l test rods showed an initial stability of 130 N/mm2 in the three-point bending test; the stability decreased after implantation in the dorsal muscle of the rat within 5 weeks to about half the initial value. The copolymer materials showed less initial strength, and the stability decreased under the same conditions much earlier. All materials showed good tissue compatibility. After a transverse section of the beagle radius was stabilized with plates and screws out of polylactide-l, a delayed bony union with callus formation was observed.
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The treatment of chronic post-traumatic osteomyelitis with soft tissue damage requires debridement followed by plastic surgical soft tissue replacement. 47 patients were treated between the period of 1983 through to 1985 with a combination of extensive sequestrectomy followed by flap cover. In 15 cases a free muscle flap (M. latissimus dorsi) and in 32 cases a pedicled muscle flap (M. gastrocnemius, M. soleus) were employed. A successful outcome was achieved in 40 of the 47 patients.
Excellent results were found to be achievable from conservative functional treatment of upper arm fractures. A critical appraisal is made in this paper of the authors' own cases and of literature published over the past 25 years for comparison of the above results with surgical therapy. The conservative functional approach was found to be the optional method to cope with closed upper arm fractures, since it provides all the advantages of surgical therapy, yet, without the risk implied in surgery. Publications on improved results from surgical therapy cannot be accepted as reasons for a general expansion of indications.
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