Biomedical subjects

P Matter

Publications and source records attributed to P Matter.

At least 37 records · Page 2Linked to original sources

PubMed1993

[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↗

PubMed1993

[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↗

PubMed1993

[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↗

PubMed1993

[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↗

PubMed1993

[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↗

PubMed1993

[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↗

PubMed1993

[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: 5 partial ruptures of the UCL, 3 Salter I and 6 Salter II fractures with a radial fragment of the proximal phalanx I; all these had conservative treatment. In addition one had a Salter II fracture with open reduction and fixation, 6 avulsion fractures which were treated twice operatively and 4 times conservatively and 3 ruptures of the ligament which needed reconstruction. In contrast to adults, we see a different, age dependent injury pattern in children. The younger had Salter-I- and II-lesions of the proximal phalanx, whereas the adolescents showed avulsion fractures and ruptures of the UCL as seen in adults. The follow-up of 17 patients one year after the accident showed in 12 a full recovery, in 4 cases full function with minor complaints and in one case an ancylosis of the MCP-joint following a postoperative infection.

Adolescent↗

PubMed1993

[Penetrating injury].

Penetrating trauma is an uncommon injury in downhill skiing. We have observed only two cases at our clinic. 15 years ago a skier collided with a trail marker. The post entered the patient's right inguinal region and left the pelvis at buttock. The patient removed the foreign body on the slope without assistance. Remarkably, the only vital structure involved was a small puncture of the duodenum. The patient had an uncomplicated postoperative course with a transient impotence lasting six months. At a follow up 15 years later the patient complained of sequelae. This season 1992/93 an English woman collided while skiing with a tree. She sustained a penetrating injury of her left thigh. We performed a careful extraction of the foreign body with a debridement and drainage of the wound. The patient had an uncomplicated postoperative course.

Abdominal Injuries↗

PubMed1993

[Case reports of Davos avalanche accidents 1972/73-1987/88].

The main aim of this analysis was to study from different point of views the registered accidents in whom people were involved caused by avalanches during the winter-periods 1972/73 to 1987/88. As a result of this study a Swiss register for all accidents caused by avalanches was produced. The final goal of the register is to compile centralized a most complete database on all the details of either the avalanche victims or of the accidents themselves. This database is to be used for further analysis of the accidents in order to provide more background information to discuss and to improve the primary care of these patients.

Accidents↗

PubMed1993

[Patient information at the Davos hospital].

The interest for medical information is generally very high. In this respect we offer patients informative video films on rehabilitation after different injuries like internal fixation of fractures, complex knee injuries and fractures of the spine. The video films are transmitted at a fixed schedule in different languages (incl. English) into the patients bedroom. The experience over the last four years has shown a very high interest and acceptance by the patients.

Aftercare↗

PubMed1993

[Developmental trends in cross-country skiing].

During the last 20 years we have treated 1,335 cross-country skiing injuries. Five percent of all winter sport injuries resulted from cross-country skiing. The peak percentage was 7.4% in winter 1989/90. Injuries of the upper extremity were found in 50.4%, followed by injuries of the lower extremity (25.8%). Injuries of the trunk were seen in 19%. Head trauma (1.1%) and skin laceration (3.7) are not frequent. We are analysing the statistical data of the last 20 years.

Adolescent↗

PubMed1993

[Snow board accidents. Multicenter Swiss snow board study 1992/93 with the cooperation of the bfu].

Snowboarding has become increasingly popular in recent years. A prospective multicenter study was therefore performed during the winter 1992/93. 345 injuries were analysed and compared with 305 healthy snowboarders on the slopes. Preliminary results show predominantly injuries of the upper extremity comparative to those suffered from alpine skiing. Protection of the hand and wrist is recommended as well as an instruction for a special technique for falling as measurements for accident prevention.

Adolescent↗

PubMed1993

[Paragliding accidents--a prospective analysis in Swiss mountain regions].

During the period from 1.1 to 31.12.90, 86 injuries associated with paragliding were analysed in a prospective study in 12 different Swiss hospitals with reference to causes, patterns, and frequencies. Spine injuries (36%) and lesions of the lower extremities (35%) were diagnosed most frequently. Surprisingly no neurological complications occurred, which is possibly explained by the solitary axial trauma. In 15 cases very severe malleolar fractures required surgical intervention. One accident was fatal due to a lung rupture. 60% of all accidents happened during the landing phase, 26% at launching and 14% at flight. Half of the pilots were affected in their primary training course. Most accidents were due to an in-flight error of judgement, such as incorrect estimation of wind conditions and a choice of unfavourable landing sites. In contrast to early reports of hang-gliding injuries, only one accident was due to an equipment failure, namely a ruptured steering line. In more than a third of all accidents, the used paraglider was not in correct correlation with the pilot's weight and experience. Inspired by the desire for a long flight, gliders of too large surface-areas were often used, leading to a more unstable flight. To reduce the frequency of paragliding injuries, an accurate choice of equipment and increased attention to environmental factors is mandatory. Furthermore education-programs should focus more on intensifying the pilot's mental and practical skills.

Adult↗

PubMed1993

[Alpine skiing--accident--and equipment studies].

According to medical statistics over the last two decades, skiing is still associated with a certain risk of accident and injury. A review of studies carried out in Davos on alpine skiing accidents covering two decades aimed at assessing the effect of safety improvements in ski bindings combined with ski shoes and skis in view of injury statistics. Five comprehensive research studies included almost 10,000 injured and non-injured skiers and experience with nearly 29,000 injured skiers treated the Davos hospital. Firstly, the causes and preceptating factors of skiing accidents were determined and the role of binding release tests assessed. Then the effect of the skier on the accident was investigated. The function of ski binding adjustments was also studied. In a fourth step comprehensive data on multicentric research project were obtained. With the growing popularity of safety bindings in the 1970's and the results of research projects, the frequency of skiing accidents seemed to diminish or at least stagnate. The annual statistics from 1974 to 93 show a reduction in the frequency of tibial fractures and simultaneous rapid increase in the frequency of injuries of the knee joint, the upper limbs and the trunk. The situation demonstrate that measurements to control the accident rate cannot be based only on accident statistics and technical developments, but must rely on further studies of the mechanism of the fall and analyses of the long-term consequences of injuries.

Alcohol Drinking↗

PubMed1993

[Complex internal knee lesions--diagnosis, indications and timing].

Ligamentous knee injuries are nowadays more often seen in the office of the family physician, mainly because of an increase in recreational sports injuries. With the help of a questionnaire one can obtain a reliable impression of the injury pattern. The clinical examination is performed in a standardized way, so even in acute ligamentous injuries a correct diagnosis can be obtained at the first examination. The diagnosis of an instability is made with an accurate clinical examination; in case of marginal cooperation of the patient the examination is performed under anesthesia. Depending on the findings, the definitive operation will follow at the same time. In case of a big hemarthrosis we recommend an a.-p. and a lateral X-ray of the knee joint for exclusion of a bony injury before proceeding with the clinical examination. An arthroscopy is indicated in effusions of unclear origin, in the suspicion of meniscal or cartilaginous damage, in a stable knee with hemarthrosis and before definitive stabilization of complex injuries to exclude further damage to other intraarticular structures. Acute ACL ruptures are only operated on in case of bony avulsion fractures, in persons very active in sport and in case of relevant concomitant injuries. Medical collateral injuries without an ACL rupture are usually treated conservatively, except if there is an additional peripheral tear of the meniscus. PCL injuries are seldom operated, except if there is a complex concomitant instability. We aim for an early reconstruction within two weeks after the accident.

Diagnostic Imaging↗

PubMed1993

[A new self-repositioning technique for fresh, anterior-lower shoulder dislocation].

In case of a shoulder dislocation there is always a question of a safe and atraumatic reduction technique if possible without analgetics or even general anesthesia. The dislocated humeral head is reduced anatomically with the help of the patient's own body weight under muscular relaxation without injuring manipulations. Even with displaced fractures of the greater tuberosity or an impression fracture of the humeral head successful reductions were obtained. We have been using this method for over three years with a primary success rate of over 60%.

Humans↗

PubMed1993

[Surgical technique in ski thumb injury].

The skier's-thumb, an instability of the ulnar collateral ligament (UCL) of the first metacarpo-phalangeal joint is one of the most common hand injuries in alpine skiing. In over 60% of our cases the ligament is ruptured, mostly near or at its distal insertion at the base of the first metaphalanx. Also a bony avulsion of the UCL at its distal insertion is not uncommon. A significant instability or a bony avulsion of the UCL with dislocation of the fragments is an indication for open reconstruction and stabilization. Good experience has been gained with a fish hook pull-out-wire technique. We describe the approach and the reconstruction technique.

Athletic Injuries↗

PubMed1993

[Patient information in surgery].

In a prospective study 50 patients undergoing a hernia repair were asked their opinion about an information sheet which was given to them preoperatively. For 94% this paper is of help; for 82% the written information has to be clarified by an additional personal talk with the doctor. Another possibility, especially good for visualisation, is the video. At the hospital of Davos there are at the moment 7 clips available to explain the treatment and the aftercare after an operation or conservative therapy in traumatology.

Adult↗