Biomedical subjects
P Matter
Publications and source records attributed to P Matter.
[Multicenter paragliding accident study 1990].
During the period from 1.1.90 until 31.12.90, 86 injuries associated with paragliding were analyzed in a prospective study in 12 different Swiss hospitals with reference to causes, patterns, and frequencies. The injuries showed a mean score of over 2 and were classified as severe. Most frequent spine injuries (36%) and lesions of the lower extremity (35%) with a high risk of the ankles were diagnosed. One accident was fatal. 60% of the accidents happened during landing, 26% during launching and 14% during flight. Half of the pilots were affected during their primary training course. Most accidents were caused by inflight error of judgement--especially incorrect estimation of wind conditions--and further the choice of unfavourable landing sites. In contrast to previous injury-reports, only one equipment failure could be noted, but often the equipment was not corresponding with the experience and the weight of the pilot. To reduce the frequency of paragliding-injuries an accurate choice of equipment and an increased attention to environmental factors is mandatory. Furthermore an education-program regarding the attitude and intelligence of the pilot should be included in training courses.
[Trauma surgery, a multidisciplinary responsibility].
Our efforts within trauma-care have to include accident-prevention, the organization of a functioning rescue-chain as well as a pluridisciplinary care of the trauma-patient. This is of special importance within the given Swiss hospital structure. For the treatment of injuries of the locomotor-system general-and orthopaedic surgeons need to cooperate. Additional training and experience in traumatology are therefore important for both specialties.
[Injury pattern of the fibular ligaments. Radiological diagnosis and clinical study].
Injuries to the lateral ligaments of the ankle require accurate diagnosis, especially because most injuries to a single ligament are not treated surgically any more. Various stress devices are in use for objective and standardized assessment of the instability of the ankle joint. In a group of 76 patients with injuries to the lateral ligaments of the ankle, we compared post-traumatic instability by a radiological stress test as done by hand or by using a Telos stress device. In 25 patients treated by surgery an additional intraoperative stress X-ray (talar tilt) was performed. The results of the instability tests done by hand versus those obtained with the Telos stress device correlated poorly (r = 0.786). A similar result was obtained by comparing the Telos stress device views to the intraoperative stress controls done by hand (r = 0.771). Only the pre- and intraoperative measurements by hand were in good correlation (r = 0.958). These results are discussed with reference to a biomechanical model and recommendations for routine diagnosis are proposed.
Clinical experience with titanium implants, especially with the limited contact dynamic compression plate system.
AO/ASIF with its collaborating laboratories has developed cold worked pure titanium material for implants with an outstanding biocompatibility. The first prospectively controlled clinical series dates back to 1966 and was reported to be most successful. Pure titanium also became the material of choice for implants to be used in patients suffering from metal allergy. Today, a long-term and well-documented experience with these implants exists. It therefore seemed logical to use pure titanium for the new limited contact dynamic compression plate (LC-DCP) system described in the previous article by Perren. Pilot clinics started to implant titanium LC-DCP in 1987, and already 271 plates have been used, mainly for the treatment of fresh fractures. Some 57 plates have so far been removed. The preliminary results are most favourable; they confirm especially the outstanding biocompatibility of pure titanium.
[Ultrasonography of meniscus lesions].
Controversy exists about the value of ultrasonography of meniscal tears. We therefore examined 101 knee joints of 99 patients in a prospective study. Prior to the arthroscopy the menisci were scanned from an independent team by using 7.5 and 10.0 MHz ultrasound waves. 81 meniscal tears were seen at arthroscopy; 36% of these tears could not be detected with the scanner (false negative results) while 20% of intact menisci showed positive echogenic structures, which were analysed as meniscal tears. It seems that ultrasonography of the menisci is still of experimental use without any clinical importance.
[Soft tissue infection--osteitis--osteomyelitis].
Statistically the posttraumatic osteitis shows a clear tendency to decrease from 1972-76 in comparison with 1982-86 (AO/ASIF-documentation). The incidence of infection varies considerably according to the different anatomical location of fractures. More recently atypical manifestations became of more importance and ask for differentiated bacteriological examinations. A close postoperative follow-up and exact wound-observations enable an immediate and adequate therapy in case of an infection.
[The radiological functional testing in fibular ligament lesions--a critical analysis and clinical study].
Injuries to the lateral ligaments of the ankle require an accurate diagnosis, especially because most injuries to one ligament are not treated surgically any more. Different stress devices are in use for an objective and standardised assessment of the instability of the ankle joint. In a group of 76 patients with injuries to their lateral ligaments of the ankle we compared posttraumatic instability by radiological stress test as done by hand or by a Telos stress device. In 25 patients treated by surgery an additional intraoperative stress X-ray (talar tilt) was performed. The results of the instability tests done by hand versus those obtained with a Telos stress device showed a poor correlation (r = 0.786). An analogous result was obtained by comparing the Telos device stress views to the intraoperative stress controls done by hand (r = 0.771). Only the pre- and intraoperative measurements by hand showed a good correlation (r = 0.958). The results are discussed with reference to a biomechanical model and recommendations for routine diagnosis are proposed.
[The treatment of fibular ligament lesions using the Ortho-Rehab shoe].
In a prospective study we examined 46 patients (14-49 years of age) with fresh ruptures of the lateral ligaments of the ankle (talar tilt greater than or equal to 10 degrees). Treatment consisted in six weeks of taping combined with wearing of a special rehabilitation shoe (Ortho Rehab). 28 patients were treated conservatively and 18 had an operative repair of their ruptured ligaments. After 8 weeks every patient was clinically controlled. Until now 35 patients were reevaluated more than one year after injury. Treatment was judged as very comfortable and positive. Working capacity was achieved after an average of 14.8 days and all patients returned to their former sports activity 3 to 8 weeks after the event. Mechanical and functional stability after more than one year are excellent with the exception of 3 cases. The results are discussed and compared with other studies.
[Ultrasonic diagnosis of meniscus lesions].
Controversy exists about the value of ultrasonography of meniscal tears. We therefore examined 101 knee joints of 99 patients in a prospective study. Prior to the arthroscopy the menisci were scanned from an independent team by using 7.5 and 10.0 MHz ultrasound waves. 81 meniscal tears were seen at arthroscopy; 36% of these tears could not be detected with the scanner (? false negative results) while 20% of intact menisci showed positive echogenic structures, which were analysed as meniscal tears. It seems that ultrasonography of the menisci is still of experimental use without any clinical importance.
[Position on "Results of diagnostic sonography in injuries of the knee joint"].
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[Accident risk and development of seriousness level of winter sports accidents].
Ski accidents are quite frequent but not alarming if we consider the benefit of the out door sporting. In the region of Davos-Klosters more than 5 Mio Km of vertical drop are performed in down hill skiing. They result in approximately 1300 accidents per year. Since 1972 more than 20,000 ski accidents were analysed. The injuries of the lower extremity have slightly decreased (44%), on the other hand we observe more injuries of the upper extremity (32%). There are only a few polytrauma patients registered, mainly on the basis of too high speed on the ski slopes. Fractures have become rather uncommon at least in relation to the complex knee injuries which today amount to 50% of all the injuries of the lower extremities. For the prevention of ski accidents a detailed control of the equipment, especially the safety bindings at the beginning of each winter season is of utmost importance.
[Accident risk in winter sports].
Ski accidents are quite frequent but not alarming if we consider the benefit of the outdoor sporting. In the countryside around Davos-Klosters more than 5 Mio kilometers of vertical drop are performed in down hill skiing. They result in approximately 1300 accidents per year. Since 1972 more than 20,000 ski accidents were analysed. The injuries of the lower extremity have decreased slightly (44%), on the other hand we observed more injuries of the upper extremity (32%). There are only a few polytrauma patients registered, mainly on the basis of too high speed on the ski slopes. Fractures have become rather uncommon at least in relation to the complex knee injuries which today amount to 50% of all the injuries of the lower extremities. For the prevention of ski accidents a detailed control of the equipment, especially the safety bindings at the beginning of each winter season is of utmost importance.
[Care of accident patients in Switzerland].
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[Bone morphology following plate osteosynthesis as measured by axial tomography].
Previous examinations using computed tomography have shown that no geometrical changes in the cross-section was induced by the plate fixation; bone density was slightly reduced (10% in average) in the entire cross-section and not only next to the plate. A tomographic analysis is presented here about the quality and the amount of bone in the affected leg, compared to the contralateral one.
[Incidence and treatment of fresh connective tissue injuries of the knee in winter sports].
For the last 18 years 21,808 alpine skiing injuries have been treated at the hospital of Davos. There is a great decline in the incidence of lower leg fractures with a contrary development of knee ligament injuries. Today half of the lower leg injuries are knee injuries. To ameliorate the documentation of all patients with acute injuries of the knee ligaments we are using a detailed questionnaire, including the mechanism of injury, release of the safety binding, skiing ability, pattern of instability and the techniques of treatment. We report of the evaluation of 145 patients with knee ligament injuries. It is the aim of that protocol to follow up all these cases up to 5 years.
[Post-traumatic osteitis following severe soft tissue and skeletal injuries of the distal lower leg and foot].
Complications after severe soft tissue- and skeletal injuries of the distal lower leg and foot are frequent. The incidence of infection is outlined on the basis of the AO-Documentation-Center in Berne. In case of infection, necrotic tissue must be eliminated and stability of the fracture has to be maintained. Cancellous bone grafts as well as microvascular plastics should only be considered in the presence of a well vascularized fracture-bed. The benefit of antibiotics and disinfectants and the interrelation between infection and allergy to implants are discussed.
[Open fractures (classification, therapeutic principles, results)].
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