For humeral shaft fractures conservative treatment, plate osteosynthesis and IM nailing are possible options according to the localization, type of fracture or additional soft tissue problems. While the majority of humeral shaft fractures is still treated conservatively, today an increasing number of fractures is felt to be suitable for ORIF. Pseudarthroses, pathological fractures, multiple fractures or polytrauma, very severe open fractures, soft tissue interposition or concomitant nerve or vascular injuries are all indications for operative treatment. We think that plate osteosynthesis is still the standard. IM interlocking nailing has been shown to be advantageous for early rehabilitation and low radial nerve damage rates. In IM nailing it is still necessary to improve the implants and implantation techniques. A retrograde extra-articular nailing technique with elastic implants is preferable. The preliminary results for a newly developed elastic nail ("Monachia Nail") in 18 patients are very promising with respect to the implantation technique, fracture healing and functional rehabilitation.

Since the diagnosis of rib fractures caused by blunt thoracic trauma is often missed on X-ray, attempt have been made to detect unknown fractures with ultrasound. Ultrasound was initially researched, as a diagnostic technique in a preliminary study of 10 patients with known rib fractures. Subsequently, in the main study, 21 patients with clinically suspected rib fractures but normal thoracic X-rays were examined with ultrasound, and rib fractures were detected in 16 patients. The diagnosis of rib fractures by ultrasound was substantiated by an increase of activity in the technetium scintigram in 11 of 11 patients. We found further increases of activity in the scintigram in two more ribs in 7 of these 11 patients. This finding is explained by the presence of nondislocated rib fractures that are veiled to ultrasound when a disconnection of the rib's contour is missed during respiration. The diagnostic procedure is explained with reference to case studies. In summary, findings recorded in this study showed that ultrasound investigation is a more reliable method of diagnosis than X-rays examination.

Since the diagnosis of rib fractures caused by blunt thoracic trauma is often missed on X-ray, attempt have been made to detect unknown fractures with ultrasound. Ultrasound was initially researched, as a diagnostic technique in a preliminary study of 10 patients with known rib fractures. Subsequently, in the main study, 21 patients with clinically suspected rib fractures but normal thoracic X-rays were examined with ultrasound, and rib fractures were detected in 16 patients. The diagnosis of rib fractures by ultrasound was substantiated by an increase of activity in the technetium scintigram in 11 of 11 patients. We found further increases of activity in the scintigram in two more ribs in 7 of these 11 patients. This finding is explained by the presence of nondislocated rib fractures that are veiled to ultrasound when a disconnection of the rib's contour is missed during respiration. The diagnostic procedure is explained with reference to case studies. In summary, findings recorded in this study showed that ultrasound investigation is a more reliable method of diagnosis than X-rays examination.

Right atrial Hickman catheters are used for long-term venous access in children suffering from leukemia and malignoma. Parenteral alimentation, blood withdrawal and bone marrow transplantation can be performed safely without high incidence of cutaneous infections and sepsis due to a long subcutaneous tunnel. Aseptic dressing changes and catheter care are the most important prerequisites for a low complication rate in the use of these catheters. Septicemia and technical complications observed following the use of 102 Hickman catheters in 81 children are reported and discussed.

Geschlossene bimalleoläre Sprunggelenksfrakturen sowie Pilon tibial-Frakturen zeigen in einem hohen Prozentsatz Weichteilschäden mit daraus resultierenden postoperativen Wundheilungsstörungen an der Medialseite des Sprunggelenkes. Die Fraktur wird entgengesetzt ihres Entstehungsmechanismus durch Supination und Invertion reponiert und anschließend zunächst die Fibula stabilisiert. Damit stellt sich die Innenknöchelfraktur häufig regelrecht ein und kann konservativ ausbehandelt werden. Bei nicht ausreichendem Repositionsergebnis wird in einem 2. Operationsschritt nach vollständiger Abheilung des Weichteildefektes der Innenknöchel stabilisiert.

The Journal of Trauma: Injury, Infection, and Critical Care: December 1986 - Volume 26 - Issue 12 - p 1155

Beckenfrakturen werden durch a. p.-Kompression, laterale Kompression oder Vertikalverschiebung verursacht. Die a. p.-Kompression benötigt nur die Standard-Röntgentechnik, da dorsale Bandanteile nicht zerrissen sind. Die Therapie ist einfach — SchluB des Bruches. Lateralkompressionen zeigen ventrale Frakturen and dorsale Bandzerreißungen. Die Elastizität des Beckens zeigt nicht immer die Ausdehnung der Verletzung. Aus diesem Grund sind CT-Untersuchungen notwendig. Die dorsale Stabilisierung hat den Vorrang. Scherkräfte verursachen Verschiebung and ausgedehnte Zerreißungen der Weichteile. Die Röntgendiagnose zeigt klare Verhältnisse — kein CT notwendig. Beckenfrakturen sind haufig Kombinationsverletzungen. Hier sind Beckeneingangs- and Beckenausgangsebenen sowie Streß-CT-Bilder zu verlangen. Wesentlichster Therapiebestandteil ist die dorsale Stabilisierung, ventral nach Olerud, dorsal mit Schrauben.

Long-Term indwelling right atrial (Hickman) catheters were placed in 37 patients undergoing bone marrow transplantation or intensive chemotherapy for acute leukemia and other malignancies. Blood sampling, application of blood products or intravenous drugs and parenteral nutrition were impressively facilitated. Parents were easily trained for catheter care at home. The median duration of function has been 85 (2-312) days. 7 catheters had to be changed because of dislocation - especially in smaller children - or fluid leakage. In 6 severely neutropenic patients bacteremia was observed which resolved without catheter removal. The cause of death in 9 children with functioning catheter was due to the underlying disease (graft rejection, relapse). The use of Hickman-catheters improved venous access and supportive care in children with acute leukemia or other malignancies at an acceptable complication rate.