[Indications for the operation of open pediatric fractures. Report of experiences over 10 years].
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Biomedical subjects
Publications and source records attributed to K Walcher.
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Eleven proximal pseudarthroses of the tibia and elevated osteotomies of the head of the tibia were treated by fitting a condylar plate; this was done at two hospitals in Berlin and Bayreuth in the course of the past ten years. In all osteosyntheses, osseous reconstruction was achieved within a favourable time. Although mounting is technically intricate, it yields immediate or at least early exercise stability.
Non-unions of the neck of the femur are still observed today in spite of all the improvements which have been made in the surgical treatment of median fractures of the neck of the femur. Linear osteotomy according to Pauwels is technical relatively simple to perform and yields good results. Such linear osteotomy is performed in children and young adults only even if the head of the femur is not rounded. Indication for alloplasty is now more liberal even in relatively young adults since cement-free implantation of total prostheses has proved successful. Indication for performing replacement of the head alone, is very rare. Palliative measures, such as Girdlestone or resection angulation osteotomy are performed in our patients subsequent to septic complications only.
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To prevent tendons from postoperative proliferation and adhesion to surrounding structures is still a main problem in handsurgery. In addition to numerous modifications of atraumatic handsurgical techniques which have been developed some sporadic attempts are made by animal experiments and clinical trials in order to avoid postoperative adhesive tenosynovitis by hormone therapy. Because of the high doses of cortisone which are required this method of treatment is generally not accepted. Using a new method of postoperative fixation of flexor tendon sutures in rabbits the possibility of a "hormonal tenolysis" by extremely high doses of cortisone could be confirmed. In a following study it is planned to perform breaking experiments on tendons after hormone therapy in order to determine the upper limit of the therapeutical range of cortisone medication.
The indications and techniques of an arthrodesis procedure, in children and adolescents, differ greatly with that of adults. And this, on account of, the growth of the epiphysis and its circulation during that period, and also, due to the thick cartilage coating the joint's surface. And therefore, only for the rare exceptions, where there are strict indications that the procedure is weeded, should it be performed, and preferably, when possible in late adolescence. It is advised to perform the arthrodesis even earlier, when it will prevent an increase in the static's impairement especially that of the feet. In general, for the seldom splintplastics one should consider autologous material, as primary choice. To conclude, special arthrodesis will be mentioned later.
Fractures and especially luxations of the pisiform bone are rare injuries of hands, of which X-ray pictures are very important. The few points and cases in the literature some own cases are added; a hitched luxation of the pisiform bone with operative reposition and fixation is exactly described.
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After testing a new method of postoperative immobilisation the tendon of the m. flexor digit. longus of 49 adult rabbits was tenotomised and resewn. Comparing to a control-group a distinctly less accentuated reaction and scarring of the connected tissues as well as calcified reactionless necrosises can be found in the histology depending of the dosage of the postoperative cortison-treatment. The cellular alterations are described in details. For a definite judgement rupturing-tests will be necessary.
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