[Synovectomy in purulent inflammation of the knee joint].
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Biomedical subjects
Publications and source records attributed to G Muhr.
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Following criteria decide on the further life of patients with acute severe trauma: how fast injuries and their severity are recognized and following therapies are managed; prior conditions for a sufficient treatment of the acute trauma patient consist in a perfect organization and a good cooperation of all specialists. Important details of the therapeutic concept, divided in 5 or 6 phases are given. Furthermore special urological aspects in cases of multiple injuries are discussed.
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The emergency-doctor system with helicopter or special ambulance services has shown its efficiency by decreasing transport lethality, increasing chances of survival, shortening stays in hospital, and lowering complication rates. The disadvantages are high costs, the rate of alarm failures, and the trend among the population of regarding the duty to provide such aid as a government task. Consequences are the improvement of the general ambulance system due to qualified health professionals, continuous supplementary training in emergency medicine and increased information to the population.
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The trend in the treatment of bone tumors links to the preservation of function. This can be achieved by a better operative technique and interdisciplinary cooperation. The microsurgery offers here new ways. After radical resection of the tumor, the defect is bridged by a plate and a microvascular free fibula graft. Additional cancellous bone grafts produced a stable reconstruction of the resected area.
Animal experimentations of the pathophysiology of bone union after combined osteosyntheses (plate + methylmethacrylate) showed that acrylic cement destroys the intramedullary blood supply. Revascularization of the cortical bone will occur from the periosteum towards the endosteum. With the stability obtained, the osteotomy heals with formation of callus which overbridges the necrotic bone. Increased soft tissue damage delays callus formation and bone revascularization. In a 9 years period, 327 patients were treated with combined osteosynthesis. 231 of them had an unstable pertrochanteric fracture and 96 were treated because of a pathological fracture. There were 9 soft tissue infections, we observed no osteomyelitis. A follow-up of the patients with pertrochanteric fractures showed 81% good and very good results. If stability was obtained, the fractures used to heal.
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Chronic insufficiency of the lateral knee ligaments is more frequent than generally known. They are more troubling than a medial one. It exists only as a rotatory -- or combined ligament instability. For treatment the joint has to be inspected thoroughly; extraarticular corrections are mandatory. The common operative technics are described; special emphasis is laid upon Hughston's procedure for antero-lateral and postero-lateral instability.
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