Biomedical subjects
Publications and source records attributed to W Starke.
The case of a 18-year-old man is presented. Within 6 month he had two accidents, each of which was enough to cause a fracture of the scaphoid bone of the same hand at a different point.
In comparison with injuries sustained in adult life, ruptures of the fibular ligaments before growth is complete are more frequently characterized by chondral, osseous and periosteal loosening, which was seen up to the 14th year of age in about 50% of our own population of 129 patients up to the 16th year of life. The average age of patients with osseous and chondral lesions was clearly lower than that of those with periosteal injuries, which was lower than that of patients with inter-ligament ruptures. Accidents at school and during school sports classes were the most frequent cause, being involved in more than 50% of cases; of the various kinds of sport engaged in soccer was the most frequent cause, accounting for 28.8% of all cases. Manual examination of ligamentous stability compared with the opposite side by roentgenoscopy without anaesthesia has proved its worth for a definite diagnosis in fresh injuries. In all cases of evident ligamentous instability operative treatment was indicated, with subsequent immobilization with a plaster cast for 6 weeks. Stable healing of the ligament and a good functional result in all cases as well as a very low rate of complications vindicate this management. Conservative therapy, especially in the age group with normally high activity levels, is now considered correct only in exceptional cases or when operative treatment is refused.
Fractures of the scapula in childhood and youth are very rare injuries. Despite the few number of cases one can clearly distinguish, with regard to the cause of the accident, the sort of forces involved and the type of fracture, between those injuries received by adults and those of children. In the case of children and youths isolated scapular injuries and a larger number of isolated fractures of the acromial and the coracoid processes can be found. For an accurate diagnosis a thorough radiological examination must be undertaken, and if necessary further special x-ray projections or on-target x-ray spot exposures.
A case of anatomical variation of the course and branching of the ulnar nerve causing a nerve compression syndrome at the wrist joint is described. Decompression and transposition as well as tenotomy of the flexor carpi ulnaris were carried out, followed by improvement in neurological findings and complaints.
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Premature development of the diploic veins in babyhood or early infancy is rare. Differential diagnosis of fracture is difficult especially in unilateral findings. The author presents a case of a 2 5/12 year-old infant with an unilateral frontal diploic vein.
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A group of 89 patients treated for abdominal traumas between 1975 and 1980 is analyzed in respect of type and cause of accident, concomitant traumas and intra-abdominal organ lesion patterns. Isolated abdominal traumas are compared with abdominal traumas within an overall polytrauma. Complications and causes of death among the authors' own patients are reported. The relatively high overall mortality rate of 38% is due to the above-average proportion of multiple traumas amounting to 72%. Multiple intra-abdominal injuries or organs, simultaneous involvement of the thorax and necessary massive transfusions result in particularly unfavourable prognoses.
The article reports on four cases of migration of Kirschner's wire after osteosyntheses at the shoulder girdle and forearm. In two patients, the wire travelled into the musculature of the neck or throat, whereas in another case the dislocated wire was in transdiaphragmal position, partly intrathoracically and partly intrahepatically. In each case, removal of the implants resulted in complication-free healing. The article gives general guidelines for treatment in order to avoid wire migration in osteosyntheses using Kirschner's wire.
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113 patients were followed up after an average period of 27.2 months postoperatively following surgical treatment of luxation fractures of the ankle joint, from a closed series of 200 operations carried out in accordance with AO principles. Unsatisfactory late results were found in Type C in 38.6% of the cases, in the total group in 29.2% of the cases. The rate of infection was about 2%. One-third of the poor results were due to pre-arthrotic deformities or damages due to accidents; over and above this, surgico-technical complications led to unsatisfactory treatment results.
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Operative treatment of luxation fractures of the ankle joint has caused a drop in poor late results, to one-quarter of the total number of patients compared with about one-half with the conservative procedure. Part of the unsatisfactory results is caused by ossifications in region of the interosseous membrane and tibiofibular syndesmoses. The incidence of such ossifications within a closed series of 200 own operatively treated cases was examined and pathogenetic factors were discussed. Further improvement of the treatment results of ankle joint fractures appears possible via subtle operation technique and omission of routine application of fixation screws for safeguarding lesions of the syndesmoses.
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