Kontinuierliche β-Blockade mit Esmolol in Kombination mit Enoximon-Gabe

BACKGROUND: The aim of this study was to assess cardiac function in vascular surgery patients with known coronary artery disease (CAD) who received continuous perioperative beta blocker therapy with esmolol alone versus esmolol in combination with the phosphodiesterase (PDE) III inhibitor enoximone. PATIENTS AND METHODS: Over a period of 24 h, 28 patients were assigned to receive heart rate (HR) control by continuous infusion of esmolol in combination with the PDE III inhibitor enoximone (Esmolol+Enoximone group) or esmolol alone (Esmolol group; n=14). Cardiac function was assessed by the use of a pulmonary artery catheter and serial measurements of plasma troponin T (TnT) und B-type natriuretic peptide (BNP). RESULTS: The heart rate significantly decreased to the target rate of 50-60 min(-1) in both groups over the observation period. Cardiac index increased significantly only in Esmolol+Enoximone-treated patients (from 2.4+/-0.2 lxmin(-1)xm(-2) to 3.1+/-0.1 lxmin(-1)xm(-2)) and was significantly higher than in the esmolol alone group (from 2.5+/-0.2 lxmin(-1)xm(-2) to 2.4+/-0.1 lxmin(-1)xm(-2)). No patient had detectable levels of cTnT perioperatively. Peak plasma BNP concentrations were significantly increased in both groups but the highest values were measured in the esmolol alone group. CONCLUSION: Inotropic therapy with the PDE III inhibitor enoximone improves cardiac function in high risk patients with known CAD undergoing vascular surgery and also when receiving systematic heart rate control by continuous infusion of esmolol.     

Erfahrungen mit medialen monokondylären Prothesen mit mobilem Plateau

Background

Unicompartmental knee arthroplasty (UKA) has become an accepted therapy for medial osteoarthritis. The main reasons for its popularity are the minimally invasive surgical technique and the reports of excellent long-term results including high patient satisfaction and good knee joint function especially in younger patients.

Objectives

The purpose of our retrospective study was to evaluate the physical activities of patients who had undergone an Oxford III medial UKA. Special attention was paid to implant positioning and osteoarthritis of the patellofemoral joint.

Materials and methods

Of 181 implanted Oxford III prosthesis, 136 (75.1%) could be followed up. The mean age at time of surgery was 65.2 years; the average time of follow-up was 4.2 years. In addition to a physical examination and x-ray, the following scores were obtained: WOMAC (Western Ontario and McMaster Osteoarthritis Index), OKS (Oxford Knee Score), KSS (Knee Society Score), UCLA activity and the Turba score.

Results

The majority of the patients (81%) returned to their sporting activity following knee surgery. Higher complication rates or progression of osteoarthritis associated with sporting activities were not observed. The active patients had significantly higher scores for the OKS, KSS, WOMAC, and UCLA scores. The correct implant position, especially avoiding overcorrection to valgus malalignment, is important for good clinical outcome.

Conclusion

Our results demonstrate that a high degree of patient satisfaction in terms of physical and sporting activity can be achieved using the Oxford III UKA for medial osteoarthritis without an increased risk for complications.     

Die Verriegelungsnagelung von Unterarmfrakturen mit dem ForeSight™-Ulna/Radius-Nagel

Objective Stable osteosynthesis of ulna and/or radius with a solid intramedullary nail, always inserted after reaming and locked proximally and distally by screws. Indications Closed and open fractures of the second to the fourth sixth of the radius and the second to the fifth sixth of the ulna. Refractures after plate osteosynthesis. Continuation of treatment after primary stabilization by an external fixator. Pathologic fractures. Contraindications Acute and chronic osteomyelitis of the forearm bones. Open growth plates. Steel allergy. Surgical Technique Prebending of nail to adapt to shape of bones. Ulnar approach through the tip of the olecranon. Radial approach directly radial to Lister's tubercle through the second extensor tendon compartment. Opening of the medullary cavity and manual reaming of the medullary cavity. Closed reduction, if possible. Insertion of the nail without hammering, if possible. Locking at base of nail with the help of an aiming device and at nail tip by freehand technique. Results In a prospective study, 40 ForeSight? nails have been implanted between June 1997 and December 2000 in 33 forearms of 32 patients (16–84 years). The radius alone was nailed in ten, the ulna alone in 16, and both bones in seven forearms. 31 fractures were fresh (including one refracture after plate removal). One malunited radial fracture had to be corrected, and one fracture was pathologic. At present, 28 fractures in 24 forearms have consolidated. Complications occurred in form of one pseudarthrosis, two delayed unions, one complete and one incomplete synostosis, but no infection. After 13 implant removals, we did not observe any refracture. The clinical results, with a mean DASH score of 11.3, corresponding to good and excellent function, are encouraging.     

Endoskopische Unterspritzung des vesikoureteralen Refluxes mit Dextranomer/Hyaluronsäure

Background

A number of bulking agents have been used for the endoscopic correction of vesicoureteral reflux in children. We present the long-term results of endoscopic use of dextranomer/hyaluronic acid copolymer (Deflux®) for VUR grade I–IV in children.

Patients and methods

Between 2004 and 2008, 21 children underwent endoscopic subureteral injection of Deflux® in 30 ureters as an outpatient procedure. Twelve children had a unilateral reflux (two duplicated systems) and nine had a bilateral reflux. The median age was 5 years (6 months to 14.9 years). Six weeks postoperatively a voiding cystourethrogram (VCUG) was performed. This study examined the disappearance of VUR and urinary tract infection (UTI) as well as the quality of life (parents’ questionnaire) during long-term follow-up.

Results

No intra- and postoperative complications were noticed. In 25 ureters (83%) VCUG showed no VUR 6 weeks postoperatively. In three children a second injection was done (two were successful). After a median follow-up of 2.5 years 27 ureters in 17 children (90%) had no UTI and VUR. The results of the questionnaire regarding quality of life were very good in the successfully treated children and the parents would choose the same treatment option again.

Conclusion

Subureteral injection of Deflux® for children with VUR is an effective treatment option for VUR with a low complication rate.     

Operative Stabilisierung der akuten/chronischen Sternoklavikulargelenkinstabilität mit autologem Grazilissehnengraft

Surgical objective

Restoration of joint stability and unimpaired, painless shoulder function

Indications

Chronic and recurrent painful instabilities of the sternoclavicular (SC) joint. Locked posterior instability.

Contraindications

A lack of autologous tendon grafts due to harvesting of all hamstring grafts during prior surgical procedures and general contraindications for surgery/anesthesia.

Surgical technique

Joint stability is restored by a gracilis tendon allograft passed through two drill holes in the sternum and the medial clavicle using a figure-of-eight configuration.

Postoperative management

Immobilization in a sling for 6 weeks with passive motion exercises followed by 6 weeks of active mobilization without weight-bearing. After 12 weeks, continuous remobilization with increasing weight-bearing.

Results

SC joint reconstruction using an autologous tendon graft in a figure-of-eight configuration can significantly improve shoulder function and pain relief. However, some impairment of shoulder function or persistent complaints may occur, which must be discussed with the patient in the preoperative setting.     

Intoxikation mit γ-Hydroxybutyrat

The drug gamma-Hydroxybutyrate (GHB), also known as liquid ecstasy, has now reached Europe. Estimating the dosage of liquid GHB is especially difficult leading to unintentional intoxication because the exact concentration is not known. We repeatedly had to treat young patients intoxicated by GHB in our intensive care unit. We describe the course and treatment of three patients with GHB intoxication. If alcohol or mixed intoxication with drugs detected in traditional hospital toxicological assays has been excluded as the cause of unconsciousness in young patients from disco's, an intoxication with GHB should be considered. The therapy is mainly symptomatic and supportive but monitoring in an intensive care unit with the option of short term respirator therapy is necessary. Serum and urine samples taken on arrival should be conserved for further investigation in a forensic institute.     

Kombinierte An?sthesie mit Epiduralkatheter Eine retrospektive Analyse des perioperativen Verlaufs bei Patienten mit radikalen Prostatektomien Eine retrospektive Analyse des perioperativen Verlaufs bei Patienten mit radikalen Prostatektomien

Patienten, die sich einer radikalen Prostatektomie (rPE) einschlie?lich retroperitonealer Lymphadenektomie (rLA) unterziehen, haben aufgrund ihres Alters und ihrer Begleiterkrankungen ein erh?htes perioperativen Risiko. Ziel dieser Untersuchung war es, den intra- und postoperativen Verlauf der standardisierten Operation rPE+rLA unter verschiedenen An?sthesieregimen zu analysieren.     

Postoperative Übelkeit und postoperatives Erbrechen nach Strabismuschirurgie bei Kindern Inhalationsanästhesie mit Sevofluran/Lachgas im Vergleich zu intravenöser Anästhesie mit Propofol/Remifentanil

BACKGROUND: Postoperative nausea and vomiting (PONV) is still one of the major problems in strabismus surgery, especially in children. In recent years many studies have been published, suggesting that choosing propofol as the anaesthetic agent may help to reduce the high incidence of PONV in children undergoing strabismus surgery. Experience with remifentanil in children is still very limited and little is known, whether propofol in combination with this new short acting opioid is also superior regarding PONV in squint surgery compared to sevoflurane/N2O. Additionally, little is known, whether the type of operation or the muscle which is operated on has any influence with respect to PONV. METHODS: Following sample size estimation, ethics committee approval and parents informed consent in a prospective, randomised, observer-blind study 105 ASA I and II children aged 3-8 years scheduled for elective strabismus surgery were assigned into one of the following groups: Group TIVA (propofol/remifentanil, n = 53): anaesthesia was induced by remifentanil 0.5 microgram kg-1 min-1 over 2 min (loading phase), followed by 3 mg kg-1 propofol along with 30% O2 in air. After endotracheal intubation anaesthesia was maintained initially with remifentanil 0.25 microgram kg-1 min-1 and propofol 10 mg kg-1 h-1 by constant infusion. In the course of the operation the infusions of the anaesthetics were adjusted to the decreasing need for anaesthesia. Group VOLATIL (sevoflurane/N2O, n = 52): anaesthesia was induced by inhalation of sevoflurane along with 50% O2 in N2O. After endotracheal intubation anaesthesia was maintained with sevoflurane 1.0-1.5 MAC along with 30% O2 in N2O and in the course of the operation the administration of the inhaled anaesthetics was adjusted correspondingly. Preoperatively collected data included gender, age, weight and history of PONV. Intraoperatively collected data consisted of data belonging to routine monitoring (heart rate, blood pressure, peripheral oxygen saturation and temperature) as well as the duration of the operation and anaesthesia and specific data regarding the operation (including the number and type of muscles as well as the kind of operation). Data collected within the first 24 hours postoperatively in the recovery room and on the ward by blinded observers included any PONV events as well as the antiemetics and analgesics applied. RESULTS: Vomiting was observed less frequently in the TIVA-group than in the VOLATIL-group (21 of 53 vs. 32 of 52, p = 0.03) within the first 24 hours postoperatively. Posterior fixation suture ("faden-operation") compared to other operations was followed rather frequently by nausea and vomiting (30 of 44 and 33 of 44, respectively), whereas recessions were rarely associated with nausea and vomiting (12 of 35 and 9 of 35, respectively). CONCLUSIONS: TIVA with propofol/remifentanil proved to be a suitable form of anaesthesia for children in this setting. Propofol showed advantages over sevoflurane/N2O with respect to PONV after squint surgery in children also when applied in the combination with remifentanil. TIVA with propofol/remifentanil may therefore be one way to reduce the high incidence of PONV in this setting, bearing in mind, that PONV is not only influenced by the regimen of the general anaesthesia but rather by the combination of many other factors, in particular the type of operation.     

Rückenmarkstumoren mit Stauungspapille

Zusammenfassung Im allgemeinen können bei Rückenmarkstumoren die Resorptionsbahnen oberhalb des spinalen Blockes die Behinderung der besonders wichtigen Liquorabflußbahnen im Konus- und Caudabereich ausgleichen. Wenn es in seltenen Fällen — besonders bei caudalen spinalen Prozessen — zu einer Erhöhung des intracraniellen Druckes und der Entwicklung einer STP kommt, so dürften neben der mechanischen Abflußbehinderung noch weitere Faktoren beteiligt sein. Neben einer sich in der Liquorproduktion auswirkenden ausgeprägten vegetativen Labilität ist vor allem eine supraläsionelle Eiweißerhöhung wirksam, die das Liquorproduktions- und Resorptionsgleichgewicht stört. Dies geht aus der Zusammenstellung von 21 in der Weltliteratur veröffentlichten Fällen und einem eigenen Fall hervor. Auffällig häufig wurden im Cisternen- und Ventrikelliquor Werte über 100 mg% Gesamteiweiß gemessen, wobei manchmal nur eine unerhebliche Dissoziation zwischen Cisternen- und Lumballiquor vorlag.

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Summary In general, with spinal cord tumours, the resorption pathways above the spinal block compensate for the obstruction of the especially important c. s. f. return flow pathways in the conus and caudal regions. If in rare cases—especially with caudal spinal lesions—a rise in the intracranial pressure occurs with the development of papilloedema, additional factors ought to be invoked as well as that of mechanical obstruction of flow. In addition to the pronounced vegetative lability affecting c. s. f. production, a supralesional c. s. f. protein elevation, which disturbs the balance of c. s. f. production and resorption, is the main relevant factor. This paper summarizes 21 published eases in the world literature and adds one personal case. Almost always total protein levels of over 100 mg% were found in the cisternal and ventricular fluids, as a result there was frequently only a trivial disparity between the cisternal and the lumbar fluids.

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Resumen En general cuando existen tumores de la columna los mecanismos de reabsorción por encima del bloqueo compensan la obstrucción del paso del líquido a las zonas de reabsorción del cono y la región caudal. Si en algún caso raro se produce un aumento de la presión intracraneal con edema papilar para explicar este fenómeno debe recurrirse a factores adicionales, además de la obstrucción mecánica del flujo del líquido. Junto con una labilidad vegetativa acentuada que afecte la producción de l. c. r. es factor relevante un aumento del contenido de proteinas por encima del bloqueo, que da lugar a trastornos del balance de producción y reabsorción del l. c. r.En este trabajo se resumen 21 casos publicados de la literatura y se añade un caso personal. Prácticamente siempre se encontró niveles de proteina superiores a 100 mg.% en el líquido ventricular y cisternal.

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Résumé En général, dans les tumeurs médullaires les voies de résorption situées au-dessus du blocage médullaire remplacent les voies de retour du L.C.R. particulièrement importantes dans la région du cône dure-mèrien.Si dans de rares cas, en particulier lors de lésions spinales caudales, une augmentation de la pression intra-crânienne se produit parallèlement au développement de l'oedème papillaire, d'autres facteurs doivent être invoqués en dehors de l'obstruction mécanique.En plus de la labilité végétative marquée qui affecte la production de L. C. R. une élévation des protéïnes supralésionnel, qui perturbe l'équilibre production-résorption est le facteur principal.L'article résume 21 cas publiés dans la littérature mondiale et apporte un cas personnel. Presque toujours des taux de protéïnes total supérieur à 100mgr. sont trouvés dans les liquides cisternaux et ventriculaires. De même qu'il y avait fréquemment une différence minime entre les liquides lombaires et de la citerne.

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Riassunto In genere nei tumori del midollo spinale le vie di riassorbimento al di sopra del blocco spinale possono compensate l'ostruzione delle vie di deflusso del liquor, particolarmente importanti, nella zona del cono midollare terminale.Quando, in rari casi, — specie in processi spinali caudali — si verifica un aumento della pressione endocranica con conseguente papilla da stasi, si deve supporre che, oltre gli impedimenti meccanici al deflusso, vi partecipino altri fattori.Accanto ad una pronunziata labilità vegetativa, che si manifesta nella produzione del liquor, agisce soprattutto un aumento dell'albumina al di sopra del blocco, che turba l'equilibrio della produzione del liquor ed il suo riassorbimento. Ciò si ricava dall'esame di 21 casi pubblicati nella letteratura mondiale e di un caso trattato dall'A. Dà all'occhio la frequenza, nel liquor delle cisterne e dei ventricoli cerebrali, di valori superiori a 100 mg% di albumina, mentre talvolta la dissociazione tra liquor delle cisterne e quello lombare era appena apprezzabile.

     

Peniskarzinom — Nachsorge mit Konsequenz

Penile cancer is a rare tumor entity but penile carcinoma is characterized by a high recurrence rate regarding local, lymphatic, and hematogenous recurrence. The critical period for tumor recurrence is in the first 5 years. Therapeutic options for tumor recurrence can be differentiated by the type of recurrence and the preceding therapy. The prognosis of local or small lymphatic recurrence-if detected early and diligently diagnosed-can be improved significantly by radical surgery. On the other hand, systemic therapy of advanced lymphatic recurrences and hematogenous metastases will influence disease progression only marginally. Based on these considerations, the follow-up of penile cancer should be risk adapted but close as suggested by our algorithm. With a reduced, but close follow-up we can offer our patients aftercare with the consequence of improved prognosis.     

Niedrigflußnarkosen mit Desfluran

Objectives: Due to its low solubility and negligible metabolism, desflurane is assumed to be especially suitable for application by low-flow anaesthetic techniques. The aim of this clinical investigation was the development of a standardised dosing scheme for low-flow and minimal-flow desflurane anaesthesia. Methods: One hundred six ASA status I–II patients were assigned to six groups according to the duration of the initial high-flow phase, fresh gas flow, and fresh-gas desflurane concentration. The median age, height, body weight, and constitution of the groups was comparable. After an initial high-flow phase using 4.4?l/min, the fresh gas flow was reduced to 0.5?l/min (minimal-flow anaesthesia) or 1.0?l/min (low-flow anaesthesia). Inspired nitrous oxide concentrations were maintained at 60% to 70%. Using different standardised schemes of vaporizer settings, inspired desflurane concentrations were applied in the range from 3.4% to 8.7%, i.e., between 1 and 1.5 MAC. Inspired and expired desflurane concentrations were measured continuously by the side-stream technique and recorded on-line. Venous blood samples were taken immediately prior to induction and 45?min after flow reduction for measurement of carboxyhaemoglobin (COHb) concentration). Results: In the 10- to 15-min initial phase during which a high fresh gas flow of 4.4?l/min was used, the inspired desflurane concentration reached values in the range of 90%–95% of the fresh gas concentration. In low-flow anaesthesia this concentration could be maintained without any alteration of the vaporizer setting, whereas in minimal-flow anaesthesia with flow reduction the fresh gas concentration had to be increased by 1% to 2%: The quotient calculated by division of the inspired desflurane concentration by its fresh gas concentration (Q=C_I/C_F) ranges between 0.65 and 0.75 in minimal-flow and between 0.80 and 0.85 in low-flow anaesthesia. If use was made of the wide output range of the desflurane vaporizer, the inspired concentration could be increased rapidly by about 5% in 8?min, although the flow was kept constant at 0.5?l/min. Compared with its value prior to induction (2.13±1.05%), the COHb concentration decreased statistically significantly by about 0.7% during the 1st hour of minimal-flow anaesthesia (1.42±1.01%). In no case was a COHb concentration observed that exceeded threatening or even toxic values, although the soda lime was changed routinely only once a week. Conclusions: The pharmacokinetic properties of desflurane, resulting in especially low individual uptake, and the wide output range of the vaporizer facilitate the use of low-flow anaesthetic techniques in routine clinical practice. Even in minimal-flow anaesthesia, the duration of the initial high-flow phase can be shortened to?min. If the flow is reduced to 1?l/min, the inspired desflurane concentration achieved in the initial high-flow phase can be maintained without any alteration of the vaporizer setting. In minimal-flow anaesthesia, however, with flow reduction to 0.5?l/min, the fresh gas concentration has to be increased to a value 1%–2% higher than the inspired nominal value. Due to the wide dialling range of the desflurane vaporizer, the amount of vapour delivered into the breathing system can be increased to about 110?ml/min even at a flow of 0.5?l/min. The large amount of agent that can be delivered into the system even under low-flow conditions, together with the very low individual uptake, results in a time-constant that is sufficiently short for the clinically required rapid increase in inspired desflurane concentrations. The short time-constant of low-flow desflurane anaesthesia improves the control of the anaesthetic concentration. If all measures are taken to safely avoid inadvertent drying out of the soda lime, there is no evidence that low-flow anaesthesia with desflurane is liable to increase the risk of accidental carbon monoxide poisoning. As the use of desflurane with high-flow anaesthetic techniques becomes wasteful, its routine clinical use from an economic and ecologic standpoint will only be justified if consistently applied with low-flow or minimal-flow anaesthesia.     

Frühergebnisse mit der gerüstfreien Bioprothese vom Typ FreestyleTM

Zusammenfassung Problemstellung: Die gerüstlose Aortenklappen-Bioprothese vom Typ Freestyle soll den gerüsttragenden Bioprothesen hämodynamisch überlegen sein. Dies veranlaßte uns zu einer prospektiven Studie mit diesem Klappentyp.¶ Material und Methode: Zwischen Mai 1996 und Juni 1997 wurde bei 58 Patienten ein Aortenklappenersatz (AKE) mit der Freestyle Bioprothese durchgeführt. Das Durchschnittsalter lag bei 73,8 Jahren (range 60-84), 45 Patienten waren über 70 Jahre alt. 29 Patienten hatten eine Aortenklappenstenose, 10 eine Aorteninsuffizienz. Um ein kombiniertes Vitium handelte es sich bei 19 Patienten. 83% der Patienten waren praeoperativ in einem Stadium NYHA III oder IV. Alle Patienten wurden klinisch und mittels transthorakaler Echokardiographie 1 Woche, 6 Monate und 1 Jahr postoperativ nachuntersucht.¶ Ergebnisse: 26 Patienten erhielten aufgrund einer symptomatischen KHK zusätzlich Bypasses. Die mittlere Ischämiezeit betrug 55min (range 41-95) bei isoliertem AKE und 71min (52-103) bei zusätzlicher Anlage von Koronarbypasses. Die perioperative Letalität lag bei 7% (4/58). Nach 12 Monaten waren 41% (24) der untersuchten Patienten im Stadium NYHA I und 53% (31) in NYHA II.¶ Schlußfolgerungen: Der Einsatz der Freestyle Bioprothese führt zu einer deutlichen klinischen Verbesserung der Patienten, die postoperativ nahezu alle in NYHA I oder II sind. Die perioperative Mortalität ist niedrig, so daß die Verwendung dieser Klappe sicher ist. Längeres Follow-up muß bestätigen, daß die günstigen Frühergebnisse persistieren und mit einer längeren Haltbarkeit der Klappe einhergehen als es bei konventionellen gerüsttragenden Bioprothesen der Fall ist. Summary Background: Stentless porcine aortic valves are considered to be hemodynamically superior to mounted bioprostheses.¶ Methods: From May 1996 to June 1997, 58 consecutive patients underwent aortic valve replacement with the Freestyle stentless bioprosthesis in the subcoronary position. Mean age was 73,8 years (range 61-84). The predominant aortic valve lesion was stenosis in 29 and regurgitation in 10 cases. A combined lesion was found in 19 patients. All patients were examined clinically and by echocardiography 1 week, 6 months, and 1 year postoperatively.¶ Results: Additional coronary artery bypass grafting was performed in 26 patients. Mean cross-clamp time was 55 min (range 41-95) for AVR and 71 min (range 52-103) with additional CABG. The inhospital mortality rate was 7% (4/58). Thromboembolism, hemorrhage, endocarditis or structural valve deterioration did not occur. At one year 41% were in NYHA class I, 53% in NYHA class II. Minimal aortic valve incompetence was seen in 19% postoperatively, in 14% at 6 months and in 9% at 1 year. There was no case of severe regurgitation.¶ Conclusions:The Freestyle stentless bioprosthesis shows good results both hemodynamicaly and clinically. Pressure gradients are decreasing and most of the Patients are in NYHA functional class I or II postoperatively. Perioperative mortality is low and no valve related complications occured suggesting this type of valve to be safe. Whether this promising valve can live up its expectations has yet to be determined in long-term follow-up studies.     

Ist die Fachrichtung assoziiert mit der Selbstsicherheit im Umgang mit rationaler Antibiotikaverordnung?

Die Anaesthesiologie - Vor dem Hintergrund einer stetig zunehmenden Gesundheitsgefährdung durch multiresistente Erreger spielt neben der Bevölkerungsaufklärung, der Fachkenntnis und...     

Plastik des vorderen Kreuzbandes mit freiem Transplantat mit Hilfe eines neuen Zielgerätes

Zusammenfassung Es wird eine Zusammenfassung der derzeit üblichen Methoden zum Ersatz des vorderen Kreuzbandes gegeben und bezüglich der Haltbarkeit und Biomechanik des Kniegelenkes diskutiert. Vom Autor wird dabei das bei der Brücknerplastik verwandte Ligamentum patellae als Kreuzbandersatz empfohlen, wobei er jedoch wegen der relativen Kürze des Kniescheibenbandes die Verwendung desselben als freies Transplantat angibt. Es wird ausführlich die genaue topographische Lage des vorderen Kreuzbandes im Kniegelenk beschrieben und ein Zielgerät zur korrekten Implantation des proximalen Kreuzbandersatzes am lateralen Femurcondylus vorgestellt.

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A new drill guide for plastic repair of the anterior cruciate ligament by a free ligamenteous graft

Summary A report of the most widely used grafts for the replacement of the anterior cruciate ligament shows the difficulties of plastic repair. The author recommends the patella ligament used by Brückner but, because of the relative shortness of this ligament, not as a distally based ligamenteous graft but as a free one. The exact topography of the anterior cruciate ligament is given. A new drill guide for repair of this ligament is described and the technique of implantation by making use of that drill guide is explained.

     

Die Behandlung komplexer Ellbogenverletzungen mit einem gelenküberbrückenden Fixateur mit Bewegungsachse

Biomechanical investigations in eight specimen elbow joints to test articulated external fixation showed correct extension-flexion joint position between 0 and 120 degrees. The central axis through the radial and ulnar condyles varies less than 3 degrees in total. X-ray cinematography showed correct articulation in all cases without subluxation. In six patients with persistent subluxation and complex fracture of the proximal ulna external fixation with an additional articulation was placed. All patients began with physiotherapy on the 3rd day after operation, the range of joint motion was 0-30-95 degrees in all cases, after 6 weeks 0-30-110 degrees. Additional articulated external fixation at the elbow joint can be an alternative treatment to long-term transfixation of the elbow in cases of complex injury.