[Treatment of congenital luxation of the radial head].
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This is the analysis of external forces acting on the elbow joint and their influence on the appearance of bending forces, shearing forces and tensions along the ulna and their alterations with fractures of the olecranon. The influence of flexor muscles on the fracture site is being evaluated too. The fracture of the olecranon is being defined by means of statics. All disadvantages of a dorsal tension band i.e. uncertainty to neutralize all forces acting at the fracture site adequately, irregular interfragmentary compression, creation of unwanted stearing forces and moments, rest on its excentric localisation. The optimal distribution of hard ware is being evaluated.
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Two cases of habitual dislocation of the elbow are presented, both of them in mentally deficient patients. Aetiology and operation methods are discussed and relevant literature reviewed.
Trauma predisposes an individual to bacterial arthritis. This report describes a case of posttraumatic bacterial arthritis with luxation of the elbow. It was necessary to perform synovectomy as a complement to systemic antibiotic treatment in order to control infection and reduce the dislocation. The use of external fixation is demonstrated.
The outcome of olecranon and patella fractures fixed with biodegradable implants (self-reinforced poly-L-lactide wire combined with self-reinforced polyglycolide screw or self-reinforced poly-L-lactide plug) or with metallic implants (tension band wiring, Kirschner wire and metallic cerclage wire) was compared in a prospective, randomized study. Twenty-five olecranon fractures (15 with biodegradable implants and 10 with metallic ones) and 10 patella fractures (6 with biodegradable implants and 4 with metallic ones) were treated. There were no differences between these methods in outcome. Olecranon and patella fractures can be treated using biodegradable implants successfully. The total expenses are lower because a second operation is not needed to remove the implants after fracture consolidation.
A long-term follow-up study of 38 fractures of the lateral humeral condyle was done to evaluate the special problems related to growth disturbances. Indications for operative treatment and clinical as well as radiographic results are discussed.
The anatomical relations of the semilunar notch of the ulna were studied in radiographs, taken in a strict lateral view, from 100 patients with elbow dislocations. The results were compared with those from a control group of 150 patients without dislocation or other radiographic pathology. We found that the coronoid process and an angle (a) formed between the axis of the ulna and a line going through the tip of the coronoid process and the tip of the olecranon were significantly smaller than those in the control group (P = 0.02). The central angle of the semilunar notch was significantly larger in the dislocation group than in the control group (P = 0.009). The smaller angle (a) and larger central angle in the dislocation group are a result of a lower coronoid process, but they are also due to the prominent tip of the olecranon. The results suggest that the dislocation mechanism is partly a hyperextension, with the tip of the olecranon as the pivot point.
A case is reported, where the median nerve was entrapped in a supracondylar humerus fracture, not preventing closed reduction. As serious impairment of the median nerve function did not improve within ten weeks, the nerve was explored and dissected out of the humerus using microsurgical technique, leading to complete recovery of the neural function. The purpose of this report is to draw attention to the fact, that the median nerve can be enclosed in supracondylar fractures reducable to good position and further, that delicate dissection of the nerve out of the bone does not necessitate sacrifice of its continuity.
A rare case of posterior dislocation of the elbow joint with an avulsion fracture of the medial humeral epicondyle and fracture of the capitulum humeri is presented. Closed reduction was insufficient. Excision of the comminuted segments of the fractured capitulum was imperative to allow an optimal return of elbow function.
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During a period of 11 years 2672 traumatic subluxations of the radial head have been treated. This accident are mostly be found from 1--4 years of patients, especially in 61.4% in women. The reposition was in all the cases conservative.
A case of primary Nocardia otitidiscaviarum infection of a skin wound over an open fracture in a previously healthy adult who suffered multiple trauma in a car accident is reported. The organism was identified in cultures of pus specimens from the infected wound. The case demonstrated the difficulties of testing susceptibility of nocardiae in vitro and the necessity of prolonged antibiotic treatment. The prevalence of nocardial infections is underestimated, highlighting the need for adequate documentation of such infections and compilation of the information by public health authorities.
Intraarticular fractures require a surgical therapy. The functional results are depending on the anatomical reconstruction of the joint surfaces and on early kinesitherapy. Remaining disabilities may be controlled in 2/3 of the cases to such an extent that no alterations are necessary in private or professional life. The overall result was very good in 23.8%, good in 36.0%, moderate in 22.3% and bad in 17.9%. These bad results are due to the rate of polytraumatized patients (18%) and the high rate of open comminuted fractures (27%).
Recently six radiographic criteria were presented which, when present, indicated that additional imaging of the traumatized adult elbow by means of CT was useful. We applied these 6 criteria to 10 cases of trauma to the pediatric elbow. CT evaluation will not change the therapy dictated by the clinical findings and conventional radiography.