We see pelvic fractures in about 50% of all multiple trauma patients. In many cases, these pelvic fractures are complicated by complex pelvic traumata, i.e., a pelvic fracture with pelvic vessel damage, neurological, visceral or soft-tissue damage, and therefore have the character of life-threatening lesions. The incidence of complex pelvic trauma is extremely high in cases of vertical and rotation instability. Most problems come from massive bleeding as a result of presacral venous plexus laceration. This venous bleeding usually tampons its self after stabilization, e.g., with an external fixator. In about half of the cases an immediate laparotomy is performed because of remaining circulatory instability, lesions of the urinary tract, or open fractures. In these cases, stabilization of the pelvis is frequently achieved by ORIF, e.g., plating of the symphysis pubis or the SI joint. Internal stabilization of the pelvis facilitates the following treatment in the ICU, especially when prone-supine positioning is mandatory due to pulmonary indications. For this reason we avoid traction techniques in displaced acetabular fractures, and we achieve stability with a joint-bridging external fixator. Treatment of complex pelvic fracture must be integrated in the overall concept of treatment. Differentiated and situation-adapted action is necessary, depending on the particular situation, as well as the personnel and technical equipment.
The still unsolved problem of aseptic loosening in total hip arthroplasties with identification of polyethylene wear particles as one of its major causes, has led to reintroduction of metal-to-metal articulations, as indicated by a few good clinical long-term results with all-metal McKee-Farrar arthroplasties. In this paper, data on 145 patients from a population of more than 1400, all with implanted McKee-Farrars, who underwent revision surgery for aseptic loosening, are collected and analysed for dependence of duration to brands of the implants and position of the cups. The surface of each of 55 revised implants was measured using a 3-D device. The results showed no interdependence between time of loosening, brand inclination of the cup and deviation in shape of ball and cup. Additionally, the deviations in shape were slight.
The still unsolved problem of aseptic loosening in total hip arthroplasties with identification of polyethylene wear particles as one of its major causes, has led to reintroduction of metal-to-metal articulations, as indicated by a few good clinical long-term results with all-metal McKee-Farrar arthroplasties. In this paper, data on 145 patients from a population of more than 1400, all with implanted McKee-Farrars, who underwent revision surgery for aseptic loosening, are collected and analysed for dependence of duration to brands of the implants and position of the cups. The surface of each of 55 revised implants was measured using a 3-D device. The results showed no interdependence between time of loosening, brand inclination of the cup and deviation in shape of ball and cup. Additionally, the deviations in shape were slight.
Zusammenfassung Das immer noch ungelöste Problem der aseptischen Implantatlockerung, als deren wesentlicher Verursacher Abriebprodukte in Form von Polyethylen erkannt worden sind, hat unter Hinweis auf einzelne gute klinische Resultate zur Wiedereinführung der Metall-Metall-Gleitpaarung geführt. In dieser Arbeit sind die Daten von 145 Patienten aus einem großen Kollektiv von über 1400 mit McKee-Farrar-Endoprothesen operierter Patienten gesammelt worden. Alle 145 Patienten mußten sich einem Prothesenwechsel bei aseptischer Implantatlockerung unterziehen. Die Daten dieser Patienten wurden ausgewertet und auf Abhängigkeiten zwischen Implantationsdauer und unterschiedlichen Fabrikaten oder Pfannenpositionen geprüft. Zusätzlich wurden die Gleitflächen von 55 der gewonnenen Implantate in einem Koordinatenmeßgerät vermessen. Es gab keine gegenseitigen Abhängigkeiten zwischen Implantatlockerung, Fabrikat, Implantatposition und Formabweichungen der Pfannen und Köpfe; die Abweichungen selbst waren von geringer Dimension.
With malignant tumors of the skeleton the same therapeutic limb-saving guidelines must apply for the proximal sections of the locomotor system--the shoulder and pelvic girdles--as for the limbs themselves, especially since amputation here can hardly be surpassed by other resectional interventions with respect to operative risk, disfigurement and functional loss. The possibilities of surgical therapy for tumorous invasion of the pelvic girdle and the extremities are considered in some detail.
With malignant tumors of the skeleton the same therapeutic limb-saving guidelines must apply for the proximal sections of the locomotor system - the shoulder and pelvic girdles - as for the limbs themselves, especially since amputation here can hardly be surpassed by other resectional interventions with respect to operative risk, disfigurement and functional loss. The possibilities of surgical therapy for tumorous invasion of the pelvic girdle and the extremities are considered in some detail.
The classification of fractures of the scapula (type A: body and process fractures; type B: neck fractures; type C: glenoid fractures) is shown, and the indications for conservative and operative treatment are described, as are the surgical approaches and operative techniques. In our hospital, 93 patients with 153 fractures of the scapula type A, B or C (ratio 1.6:1) were treated. This ratio was 1.7:1 in patients treated by operation. The indication for operation was usually glenoid fractures with accessory process fractures.
Osteosynthesis can only be successful in the pelvis if one has a biomechanical understanding of the physiological flux of force from the neck of the femur via the acetabular fossa to the sacroiliac joint. The sacroiliac ligaments have a particularly important support function here. For assessing stability and classifying the traumatic patterns it is helpful to use Pennal's classification, which takes the direction of the action of force into account. Three basic forms can be distinguished: anteroposterior compression, lateral compression and vertical avulsion. Depending on the extent of the traumatic pattern one can distinguish three subtypes. Type 1 is treated conservatively while types 2 and 3 require surgical treatment. The traumatic patterns and treatment techniques applied are described clearly and with good illustrations.
The classification of fractures of the scapula (type A: body and process fractures; type B: neck fractures; type C: glenoid fractures) is shown, and the indications for conservative and operative treatment are described, as are the surgical approaches and operative techniques. In our hospital, 93 patients with 153 fractures of the scapula type A, B or C (ratio 1.6:1) were treated. This ratio was 1.7:1 in patients treated by operation. The indication for operation was usually glenoid fractures with accessory process fractures.
In cases of high-energy trauma, it is well known that there is a high incidence of pelvic fractures. The mechanism of injury, inspection and physical examination of the victim at the accident site direct attention to a pelvic fracture. In most cases, the first radiological examination (A.P. X-ray of the pelvis, oblique view of the obturator and oblique view of the ilium) shows the extent of the bony lesion. The diagnosis and therapy of lesions of the urinary tract, of intra-abdominal organs and blood vessels are vitally important. For the definitive operation of unstable pelvic ring fractures, additional diagnostic means, i.e., CT scans to distinguish posterior instability, can be necessary. Osteosynthesis can only be successful in the pelvis if one has a biochmechanical understanding of the physiological flux of force from the neck of the femur via the acetabular fossa to the sacroiliac joint. The sacroiliac ligaments have a particularly important support function. For assessing stability and classifying the traumatic patterns, it is helpful to use Pennal's classification, which takes the direction of the action of force into account. Three basic forms can be distinguished: anteroposterior compression, lateral compression and vertical avulsion. Depending on the extent of the traumatic pattern, one can distinguish three subtypes: type 1 is treated conservatively while types 2 and 3 require surgical treatment. The biochmechanics, traumatic patterns, diagnostics and treatment techniques applied are described clearly and with good illustrations.
In cases of high-energy trauma, it is well known that there is a high incidence of pelvic fractures. The mechanism of injury, inspection and physical examination of the victim at the accident site direct attention to a pelvic fracture. In most cases, the first radiological examination (A. P. X-ray of the pelvis, oblique view of the obturator and oblique view of the ilium) shows the extent of the bony lesion. The diagnosis and therapy of lesions of the urinary tract, of intra-abdominal organs and blood vessels are vitally important. For the definitive operation of unstable pelvic ring fractures, additional diagnostic means, i. e., CT scans to distinguish posterior instability, can be necessary. Osteosynthesis can only be successful in the pelvis if one has a biochmechanical understanding of the physiological flux of force from the neck of the femur via the acetabular fossa to the sacroiliac oint. The sacroiliac ligaments have a particularly important support function. For assessing stability and classifying the traumatic patterns, it is helpful to use Pennal's classification, which takes the direction of the action of force into account. Three basic forms can be distinguished: anteroposterior compression, lateral compression and vertical avulsion. Depending on the extent of the traumatic pattern, one can distinguish three subtypes: type 1 is treated conservatively while types 2 and 3 require surgical treatment. The biochmechanics, traumatic patterns, diagnostics and treatment techniques applied are described clearly and with good illustrations.
Osteosynthesis can only be successful in the pelvis if one has a biomechanical understanding of the physiological flux of force from the neck of the femur via the acetabular fossa to the sacroiliac joint. The sacroiliac ligaments have a particularly important support function here. For assessing stability and classifying the traumatic patterns it is helpful to use Pennal's classification, which takes the direction of the action of force into account. Three basic forms can be distinguished: anteroposterior compression, lateral compression and vertical avulsion. Depending on the extent of the traumatic pattern one can distinguish three subtypes. Type 1 is treated conservatively while types 2 and 3 require surgical treatment. The traumatic patterns and treatment techniques applied are described clearly and with good illustrations.
The most frequent complications in response to a fracture of the femoral neck, a typical injury of the elderly, are necrosis of the head of femur and pseudoarthrosis of the femoral neck. Only the around dressed down fracture can be conveyed to conservative treatment. The classification of AO takes these problems into consideration. One possibility to preserve the femur head is by operative insertion of a dynamic hip screw (DHS). Specific problems of the diverse types of fracture and their surgical details are taken into special account.
The diagnosis and treatment of pelvic fractures and dislocations demand that the pelvic girdle and the acetabulum be examined separately. Fractures of the pelvic girdle are present in more than 60% of cases but have to be stabilized only in 9%, in contrast to acetabular fractures, which need to be reduced and internally fixated in 55%. Combined fractures need surgical management in 66% of cases. Fractures of the pelvic girdle are best diagnosed by means of plain radiograms and computed tomograms to distinguish posterior instability. These techniques are the basis of the treatment plan for external or internal fixation. External fixation is an effective method from the aspect of hemorrhage control but not sufficient to avoid postoperative pain. Early open reduction and internal anterior and posterior fixation is the treatment of choice if good rehabilitation is to be achieved. Acetabular fractures occur mostly in young patients. Only accurate articular reduction of displaced fractures can bring about a good functional result, as this minimizes posttraumatic arthritis. Radiological evaluation is done with three standard views: 1. A. P. X-ray of the pelvis; 2. oblique view of the obturator; 3. oblique view of the ilium. When those are considered in combination with a CT scan, acetabular fractures can be classified. The Letournel classification is extremely important for reduction and fixation, as no one surgical approach has been found that is satisfactory for all acetabular fractures. Internal stabilization is provided with single screws and plates.
