In 1990 Swiss health care expenditures totaled 26.3 billion Swiss francs, corresponding to 7.8% of the gross national product. Over the last 5 years expenditures have increased by 43.1%. Given the economic and political realities, future endeavors must be directed at stemming escalating costs. As 51.5% of health care resources are spent on hospital care, a substantial portion of financial restrictions and reorganization have been directed at this sector. These restrictions on hospital care have a direct impact on surgical practice and education. The resulting concentration of manpower and resources demand a new definition of the role of the general surgeon within the revised hospital system. In the face of a dilution of experience and knowledge due to an increasing number of specialized surgeons, the role of the general surgeon who provides basic surgical care must be redefined. These new trends must also be integrated into future training programs. The introduction of a structured surgical curriculum can limit the number of surgical trainees and maintain a high standard of quality.

Delivery of Health Care↗

PubMedDate not supplied

[Fracture behavior of AO 3.5 mm cortical titanium screws Synthes screws) combined with LC-DCP plates].

AIM: It was investigated if AO 3.5-mm titanium cortical screws used in combination with LC-DCP plates for osteosynthesis are likely to break during surgery. METHOD: The moments of torque that lead to breakage of the screw were determined experimentally in a hardwood model. The insertion angle was variable: 90 degrees in centric (n = 30) and excentric (n = 30) positioning, 70 degrees (n = 30) and 50 degrees (n = 30). Minimal moments that led to screw breakage were compared to insertion moments that were measured intraoperatively in 7 fracture operations (radial, ulnar, tibial, fibular; 32 screws). RESULTS: Minimal moments that led to screw breakage were 2.6 Nm (90 degrees centric), 2.8 Nm (90 degrees eccentric), 2.7 Nm (70 degrees) and 2.4 Nm (50 degrees). The maximal intraoperatively measured insertion moment was 2.25 Nm (radius). CONCLUSIONS: In this investigation, minimal moments that led to screw breakage in an experimental setting were higher than maximal insertion moments that were recorded during surgery. It is concluded that screw breakage related to the given implant combination is unlikely if correct surgical technique is performed.

Bone Plates↗

PubMedDate not supplied

[The decentralized documentation system '90' of the Study Group for Osteosynthesis Problems (AO)].

The new decentralized documentation system '90' of the "Arbeitsgemeinschaft für Osteosynthesefragen" (Association for the Study of Internal Fixation to ASIF) will be introduced. This system is used for gathering clinical data of operatively treated fractures and their clinical outcome.

Cross-Sectional Studies↗

PubMedDate not supplied

Skier's thumb. Surgical treatment of recent injuries to the ulnar collateral ligament of the thumb's metacarpophalangeal joint.

Acute rupture of the ulnar collateral ligament of the metacarpophalangeal (MCP) joint of the thumb is often sustained in downhill skiing accidents an is hence called "skier's thumb." All complete ruptures seen at our hospital between 1975 and 1979 were operated using the "fishhook" pullout wire technique. Follow-up results 29 months after early operation are presented for 47 cases. The overall results are excellent in 29, good in 14, and fair in 3 patients. Our result had to be considered a failure. No patient had serious functional impairment or major constant pain. No patient took any pain medication. No reintervention was necessary. The distal bony avulsions showed the most favorable prognosis, and the ligamentous midsubstance tears, the least favorable. The fishhook pullout wire technique can be used in both ligamentous and bony avulsions of the ulnar collateral ligament and provides good or excellent results in 90% of the cases.

Athletic Injuries↗

PubMedDate not supplied

Skier's thumb--the significance of bony injuries.

In a retrospective study to determine the anatomic nature of injuries in thumbs that were treated surgically for either fracture or instability, we reviewed 63 consecutive patients with acute skier's thumb injury. Of the 63 thumbs, 25 (40%) had a fracture. Surgical exploration showed 2 fracture types: a fragment that was attached to the ulnar collateral ligament, and a fragment that was not attached to the ulnar collateral ligament. The 1st type, corresponding to true avulsion fracture of the ulnar collaternal ligament, was found in 8 cases; the same fracture type was seen in another 7 cases, with an isolated fragment that was not attached to the ligament. Such an isolated fragment was observed in 10 other cases in which the ulnar collateral ligament was completely disrupted. This type of bony fragmentation cannot be differentiated from a bony avulsion of the ulnar collateral ligament on routine films. Therefore, stress testing the injured thumb is mandatory even when bony avulsion fracture with minimal displacement is suspected from a radiograph, as indeed the fracture may not be a bony avulsion but may be a fragmentation of the ulnar volar aspect of the proximal phalanx associated with a complete disruption of the ulnar collateral ligament.

Bone and Bones↗

PubMedDate not supplied

Open fractures. Long-term results in 200 consecutive cases.

Two hundred consecutive patients admitted with 214 open fractures were reevaluated 6--10 years following injury. All patients were seen in follow-up by the authors. The average hospital stay was 36 days. Many of the patients sustained multiple injuries in automobile accidents. Concomitant head, chest or abdominal trauma occurred in 41% of the patients; 38% sustained multiple fractures. The average patient achieved full weight-bearing at 28 weeks. Late complications were infrequent. All postoperative bone infections (7%) were eradicated with appropriate treatment an average of 27 months postinjury; all of the infected fractures united, and no major limitations of motion resulted. Roentgenograms taken an average of 8 years postinjury revealed only 9 patients with major joint incongruities or arthritic changes. All of the fractures were united except for one with an asymptomatic fibrous union of the patella. Anatomic restitution was possible in most patients. Only one patient had an axial malalignment which necessitated correction by osteotomy and 6 patients had shortening of 1 cm or less. The functional results were excellent with only minor limitations of motion having been found in 25 patients. Disability payments were made to 39 patients and all patients (except for the one who retired due to age) had returned to their prior jobs.

Femoral Fractures↗