[Treatment of fragments, loss of bony substance and pseudarthrosis of femur and tibia using screw fixation (40 cases)].
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Biomedical subjects
Publications and source records attributed to I Kempf.
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Sulfan blue is a vital dye which can be injected intravenously before a surgical procedure and produces a greenish coloration of all vascularised tissues. The authors describe the technique of its use and its toxicity. This technique makes it possible to recognize during an operation all devitalised tissues and to excise them with greater accuracy.
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The authors have conducted a clinical and biomechanical study of blind nailing of trochanteric fractures by the Ender's technique. The nail is introduced through the medial femoral condyle. The study was based on 120 operations. From the biomechanical standpoint, the authors studied the forces exerted in the medullary canal of the femoral shaft and the grip of the nail in the head and neck of the femur. In most of the cases the technique allowed immediate walking with weight-bearing. The results are compared with those obtained after nail-plate fixation. They were superior on three counts--less infection, less breakage of inserted material and less non-union, but the technique produced more mal-union. For this reason, the authors consider it to be an excellent technique but to be reserved for older patients.
Among cases of recent or long-standing post-traumatic laxity of the knee ligaments, unstable lateral rotation is due to a well-defined anatomical lesion, viz. Rupture of the medial capsular ligament of the knee. This laxity is demonstrated clinically by the existence of an abnormal postero-anterior movement when the tibia is in lateral rotation. Its surgical treatment, suggested by D. Slocum, consists of displacement of the patella tendon. This rupture may exist alone but, usually, is associated with other ligamentous or meniscal lesions for which further specific treatment should be carried out. Slocum's operation has recently been used in the Strasburg Accident Centre. The early results are encouraging.
The authors have treated 25 unstable trochanteric fractures in old people by valgus osteotomy and nail-plate fixation. In 6 cases a medial translation was added. Walking with weight bearing was started 7 to 14 days after the operation. The results were satisfactory in only 14 cases. The authors think that this type of fixation is logical on a bio-mechanical standpoint. However they conclude that the procedure is not fiable enough.
The authors have treated 399 fractures of the femoral shaft by blind nailing with reaming following Kuntscher's technique. They fully describe the necessary technical details for a safe operation. They emphasize the importance of an adequate instrumentation and report peroperative complications and the way for avoiding them (poor reduction of the fractures, difficulty for bridging the fracture site, creating of additional fragments, blockage of reamers or nails in the medullary canal). Indications and results are described. I non-union, 15 malunions and 4 sepsis were reported.
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