[Swiss Surgery--the first volume in the readers' opinion (assessment of the December 1995 questionnaire)].
Explore the source record for details and available documents.
General Surgery↗
Biomedical subjects
P Matter
Publications and source records attributed to P Matter.
[35 years fracture documentation by the Working Group for Osteosynthesis Problems (AO)].
35 years of AO-Documentation has clearly demonstrated the possibilities and the effectiveness of fracture documentation. The fracture classification, x-ray documentation and recommended evaluation scores are essential prerequisites for trend analysis and comparison of results. AO offers today the methodology for a decentralized data collection and scientifically planned clinical trials.
Data Collection↗
Documentation.
In the period from 1. January to 31. December 1992, the new pinless external fixator was applied in eight European and North American clinics as part of a prospective multicentric study run by the AO/ASIF Documentation Centre. The aim of this study was to determine the indications, handling, and clinical results with the new fixator. The new pinless fixator was used 77 times on a total of 75 patients. The main indications were fresh tibial shaft fractures for which immediate definitive treatment was impossible. The majority of cases were secondarily stabilized with an unreamed tibial nail once the local and/or general condition of the patient had improved. In the remaining cases the pinless fixator was used for calcaneal and tibial head traction, segment transport and temporary stabilization in cases of tibial infection. Only after long-term application of the fixator was local infection at the pin site observed. There were no other complications. The new pinless fixator is a valuable addition in the treatment of fresh tibial fractures, in particular, in those cases which cannot be primarily treated due to contributing factors whether local or general.
Adult↗
Arthroscopically assisted treatment of lateral tibial plateau fractures in skiers: use of a cannulated reduction system.
A prospective study was performed on 16 patients with lateral tibial plateau fractures. All injuries were associated with alpine or cross-country skiing. Included in the study were those patients with an articular surface depression of > or = 2 mm with radiographic findings consistent with the AO/ASIF classification of tibial plateau fractures (41 B2.2/B3.1). A combined procedure was performed with arthroscopic visualization of the knee joint and utilization of a cannulated plateau elevator. All fractures were reduced with this device with subsequent autogenous bone graft and, when indicated, transverse cancellous lag screw fixation. Follow-up was 1-6.5 years for the 16 patients, with all but two reporting resumption of activity to preinjury levels.
Adult↗
Pinless calcaneus traction: a preliminary report.
Calcaneus traction with a Steinmann-pin or K-wire inserted into the dorsal aspect of the calcaneus is a common temporary procedure in fractures of the lower leg when internal fixation has to be delayed. Infection due to this simple manoeuvre is rare, but is a very serious complication. In 1991, a so-called pinless external fixator was introduced in clinical trials, based on the idea of external fixation without transosseus pins, thus preserving local blood supply and lowering the risk of pin track infection. This pinless clamp also represents a handy tool for calcaneus traction. We have used this pinless clamp for calcaneus traction in 39 patients without any major problems or complications. Of these, 29 patients were scheduled for delayed internal fixation, and in 10 patients this clamp was used intraoperatively in closed tibial nailing for traction on the fracture table. Tips and tricks for the use of this pinless clamp, and its advantages and disadvantages are discussed.
Adolescent↗
[Clinical results with the limited contact DCP plate of titanium--a prospective study of 504 cases].
From the beginning of 1988 to July 1991, ten Swiss and German clinics undertook to document all cases of internal fixation using the titanium LC-DCP as part of a prospective multicenter study. The follow-up period was 14.2 months on average. The clinical results of 504 fixations were convincing. The follow-up rate was 72%. Of these, 95% healed without complication. The most frequent complication was delayed healing which occurred in 2.5% of cases. The infection rate was low (1.1%). A separate comparison of DCP fixations on the tibial shaft in 1984-1988 demonstrated the obvious biological compatibility of the new plate and shows that excellent results can be obtained using plate fixation.
Adult↗
[Epidemiology of internal knee injuries in Alpine skiing].
The incidence of sport injuries in Switzerland is twice as high compared to traffic injuries. Soccer and alpine skiing play the most important role in sport injuries. For the last twenty winter seasons all winter sport injuries were analysed at the hospital of Davos. About 85% are injuries caused by alpine skiing resulting in a total of 24,684 for the last twenty years. There is a great decline in the incidence of lower leg fractures with a contrary development of knee injuries. The treatment-quotient (amount of knee injuries in alpine skiers per 10(4) kilometers of vertical drop skied) has increased over the last seasons. Nowadays one part of four skiing injuries is an injury of the knee ligaments. In skiing areas favored by beginners, we have observed an incidence of knee ligament injuries three times as high compared to other areas. Since 1986 we have evaluated 206 patients operated for knee ligament injuries, 44% with unidirectional and 56% with multidirectional instabilities. We report about the preoperative data.
Adolescent↗
[Skier's thumb injury in the child].
Acute rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb (skier's thumb) is a common skiing injury in adults. Do we find this injury in children? Of the 302 skier's thumbs during the last 4 years we found 24 (8%) injuries in children (mean age 13.4 years) with open growth plates. They had the following diagnosis and consecutive treatment: 5 partial ruptures of the UCL, 3 Salter I and 6 Salter II fractures with radial fragment of the proximal phalanx I; all these had conservative treatment. In addition one had a Salter III fracture with open reduction and fixation, 6 avulsion fractures, which were treated twice operatively and 4x conservatively and 3 ruptures of the ligament which needed reconstruction. Supposing the trauma mechanism in adults, we see a different, age-dependent injury pattern in children. The younger had Salter-I- and Salter-II-lesions of the proximal phalanx, where as the adolescents showed avulsion fractures and ruptures of the UCL as seen in adults. The follow-up of 17 cases minimally 1 year after the accident showed in 12 a full recovery, in 4 cases small subjective symptoms but full function and in 1 case an ankylosis of the MCP-joint following a postoperative infection.
Adolescent↗
[Ruptured cystadenoma of the pancreas].
There are many potential reasons for an acute abdomen. Very rare is a rupture of a cystadenoma of the pancreas. We describe such a case of an 85-year old woman, who was treated with an internal drainage of the cyst with a Roux-Y-loop, as at the time of the emergency operation the histological diagnosis was not known. As for the age of the patient and her general condition a secondary procedure with total resection of the mucinous cyst was not carried out. The post-operative course was uneventful up to three months, when the patient died in a geriatric home due to a antibiotic-resistant urosepsis. Literature is reviewed and our case is discussed in respect to recent publications.
Abdomen, Acute↗
[Preoperative arthroscopy in fresh complicated internal knee lesions].
In a prospective study, 197 preoperative arthroscopies were carried out on 194 patients with fresh severe internal lesions of the knee. The injuries are analyzed, with reference in particular to diagnosis and treatment of additional meniscus lesions. Advantages and disadvantages of the procedure are discussed.
Adolescent↗
[Arthroscopically guided osteosynthesis of lateral tibial plateau fractures].
A prospective study was performed on 16 patients with lateral tibial plateau fractures. All injuries were associated with alpine or cross country skiing. Included in the study were those patients with a 2 mm or greater articular surface depression with radiographic findings consistent with the AO/ASIF classification of tibial plateau fractures, 41 B2.2./B3.1. A combined procedure was performed with arthroscopic visualization of the knee joint and utilization of a cannulated plateau elevator. All fractures were reduced with this device with subsequent autogenous bonegraft and when indicated, transverse cancellous lag screw fixation. Followup was from 1 to 6.5 years for the 15 patients with all but two reporting resumption of activity to pre-injury levels.
Adult↗
[Epidemiology of winter sport injuries].
The region Davos/Klosters is a big wintersport area in Switzerland, where more than 5 million kilometers of vertical drop are skied per year. Over the last 20 years 28,777 patients with wintersport accidents have been treated in the 100-bed hospital of Davos, 85% of these patients have sustained their accident while skiing. An analysis of these datas show an increase of ski accidents as well as an increase of the distance skied. Especially an increase in snowboard accidents is noted over the last few years with a preponderance of lesions of the upper extremity. Injuries of the head, the trunk and simple skin lacerations remain stable over that period. Injuries of the upper extremity are increasing, whereas lower extremity lesions are slightly decreasing. There is a significant decrease of fractures of the leg, while at the same time an important increase of knee injuries is noted. Young patients below 20 years and those between 31 and 40 years of age sustained less accidents over the last 20 years, while the rest of the alpine skiers remain more or less stable in their accident incidence.
Adolescent↗
[Osteosynthesis with the titanium limited contact DCP-plate].
During the period from the beginning of 1988 until July 1991 all LC-DCP plate osteosynthesis at the hospital of Davos have been documented in a prospective multicenter study and were followed up after a meantime of 17.6 months. The clinical results of the 57 implantations at the hospital of Davos were excellent as the results of the overall study. 98% of all reexaminated patients (follow up rate 81%) had an uneventful clinical course. The results demonstrate the good biological tolerance of the new plate and underline, that in combination with a careful soft tissue handling excellent clinical outcomes can be reached with this plate osteosynthesis.
Adolescent↗
[Calcaneus extension with the pinless external fixator].
Calcaneus traction is a common temporary procedure in fractures of the lower leg, when an internal fixation is not permitted for soft tissue reasons. Usually a Steinmann-pin or a K-wire is driven across the calcaneus, which is a simple manoeuvre performed in local anaesthesia. Infection due to this perforation of the calcaneus are rare, but signify for the patient a catastrophic complication. With the introduction of the pinless external fixateur in 1991 in clinical trials a very handy pinless-clamp exists, which can safely be anchored in the heel and thus permits safe calcaneus traction without any transosseous fixation. We have used this pinless clamp in 39 patients for various reasons and haven't stated any major complications. The clamp has proved to be very useful for temporary traction as well as for the fixation of the leg during closed intramedullary nailing using the fracture table.
Adolescent↗
[Traumatic hip dislocations. Epidemiologic data at Davos Hospital and a multicenter study in Graubünden Canton].
We report about 86 patients with traumatic dislocation of the hip. Group 1 consisted of 26 patients of the hospital of Davos, group 2 of 60 patients of a multi-center evaluation of 7 hospitals in the Kanton Graubünden. 53 were males and 33 females. 13 patients were 16 years old or younger, of these 5 below 10 years. 69% are injuries in sports, 66% in alpine skiing. 78 had a posterior, 5 an anterior and 3 central dislocation with a fracture of the floor of the acetabulum. Concomitant local injuries were seen in 76.9% of traffic accidents and only in 22% of skiing injuries. Closed reduction was performed in 81 patients on the average less than two hours after injury, in 5 cases an open reduction was necessary. The subsequent treatment was in 15 cases operative, consisting in reconstruction of the concomitant injuries.
Adolescent↗
[Controlled weight bearing after osteosynthesis].
Patient compliance with postoperative partial weight bearing can be a difficult management problem. The problem may be intentional or unintentional. There is no objective way to assess the amount of weight placed on the lower extremity by the patient. It is our clinical suspicion that patients place more weight than is desirable on the effected limb. There are few reports in the literature on this topic. One study has confirmed our suspicion of poor patient compliance with postoperative weight bearing. Our goal is to develop a system to accurately assess weight bearing and to improve this aspect of postoperative fracture care. Through an active feedback device we hope to improve patient education and understanding. We plan to study the clinical applications of using a pressure sensitive shoe insert device. Our ultimate goal is to improve upon the present device and to study the clinical application of there use.
Biomechanical Phenomena↗
[The initial traumatic shoulder dislocation. Prospective study].
The goal of this prospective study was to investigate possible factors which might prevent the recurrence of dislocation after a first time traumatic shoulder dislocation. Of the 504 patients initially recorded, 376 were followed up clinically and radiologically after 1 year, and 324 were followed up after 5 years. 20% (64/324) of the patients examined after 5 years sustained a recurrent dislocation of the shoulder. We can confirm age dependency in the occurrence dislocations (50% of the patients > 30 yrs; 15% > 30 yrs). However, we were unable to find a relationship between the duration of immobilization and the incidence of recurrence redislocation (20% recurrence for 0, 1, 2, 3, > 3 weeks of immobilization). A simultaneous avulsion fracture of the tuberculum majus seems to improve the prognosis for recurrent shoulder dislocation (3/114 = 3%), whereas other bony injuries detected using conventional radiology do not appear to influence the incidence of recurrence. A shoulder stabilisation operation had to be carried out in a total of 10% of the follow-up cases. Based on our experience, we recommend a sufficiently long immobilization period of the freshly injured shoulder. In young patients, extensive and invasive procedures (arthro-MRI, pneumo-arthro-CT, shoulder arthroscopy) should be carried out after the first redislocation.
Adult↗
[Analgesic-free self-reduction of acute shoulder dislocation].
Incidence and severity of shoulder lesions are increasing especially in alpine skiing accidents. In case of a shoulder dislocation there is always the question of a safe and atraumatic reduction technique if possible without analgetics or even general anesthesia. We present a new reduction technique with the help of the patient's own body weight under muscular relaxation. Even in the presence of displaced fractures of the greater tuberosity or a depression fracture of the humeral head successful reductions were obtained. After the reduction, the arm is immobilized in a Gilet. The patient is able to leave immediately after a radiographic control. We have been using this method for some years with a primary success rate of about 60 per cent.
Adult↗