Probleme mit dem γ-Nagel - Optimierungsmöglichkeiten

Intramedullary nailing implants have now assumed the first place in the treatment of pertrochanteric fractures.The reasons for their popularity are their high fatigue strength and the minimally invasive surgical technique required for their use.These advantages are of great benefit to the mainly geriatric and frequently multitraumatized patients concerned.The main device in this implant group is the gamma nail, which was originally developed by Grosse and Kempf. The gamma nail yielded results superior to those obtained with the dynamic hip screw, which had been the standard so far, especially when it was used in the treatment of unstable fractures.Although there was some vigorous debate over the original principles of the gamma nail, the current system is widely accepted and is available in different variants.However,owing to the high complication rate when the system was first introduced, the original gamma nail acquired the reputation of being an implant whose use made high demands.The critical analysis of implant-specific problems associated with the original gamma nail resulted in improvements to the implant and the instruments, with a noticeably reduced complication rate and better surgical technique.This article describes its current state of development.The various components are discussed individually. The results of our own investigation appear at the end of the report, reflecting this development process.     

Fehlheilungen und Pseudarthrosen am proximalen Femur

This article deals with malunions after treatment of trochanteric and femoral neck fractures. It focuses on the biomechanical aspects of failed osteosynthesis while also discussing in equal measure the human factors related to surgeons and patients. This article only considers the fundamental clinical aspects of malunions as a comprehensive review of all complications and treatment options is not feasible.     

Fehlheilungen und Pseudarthrosen am proximalen Femur

Trauma und Berufskrankheit - Der vorliegende Beitrag befasst sich mit Fehlheilungen nach der Behandlung von Frakturen des Schenkelhalses und der trochantären Region. Dabei liegt der Fokus auf...     

Hip screw migration testing: First results for hip screws and helical blades utilizing a new oscillating test method

Despite continued improvement in the methods and devices used to treat intertrochanteric fractures, there remains an unacceptable amount of failures. The cut‐out rate for hip screws has been recorded up to 8.3%. To evaluate the migration of different implants under physiological loads, a multiplanar biomechanical test method for hip screws was developed, the first to incorporate a simulation of the human gait cycle by an oscillating flexion/extension movement of the test device. The new method was used to compare different hip screw and blade designs with respect to their directional migration resistance. The test method generated failure modes that were consistent with those observed clinically. Under cyclic loading, the hip screws migrated predominantly in a cephalad direction. In contrast, the helical blades exhibited a distinct migration in their axial direction. The Gamma3 hip screw design showed a significantly higher migration resistance compared with other screw and helical blade designs. The results demonstrate the ability of hip screws to significantly reduce axial migration and prevent cut‐out under simulated walking loads. Further, the new multiplanar test method creates a physiological environment that can be used to optimize designs for intertrochanteric fracture fixation. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:760–766, 2011     

Frakturen des oberen Sprunggelenks beim älteren Patienten

The number of ankle fractures in elderly patients is increasing. The aim of treatment of ankle fractures in the elderly is to guarantee a possible unlimited autonomy and quality of life for patients. This is achieved by minimization of the complications and impairments after ankle joint fractures. Decisive for the further course is the initial treatment. The results are essentially determined by the soft tissue management, reduction and stable osteosynthesis; however, an orthogeriatric co-management with the implementation of treatment paths and standard operating procedures is recommended. The advantages of an interdisciplinary cooperation of trauma surgeons and geriatricians are obvious in this situation.     

The Homeless Child Health Care Inventory: assessing the efficacy of linkages to primary care.

Each year, the New York City homeless family shelter system provides transitional housing for nearly 20,000 homeless children. While the health care needs of these children are substantial, there is currently no system-wide mechanism for ensuring that they have access to appropriate medical care. This report analyzes information from the Homeless Child Health Care Inventory, a survey conducted by Montefiore Medical Center''s Division of Community Pediatrics, to examine the adequacy of health care resources available to the homeless children in New York City. Results showed that available health care resources varied considerably throughout the shelter system and that nearly 50% of homeless children in New York City did not have access to appropriate medical care.     

Primary leiomyosarcoma of the sigmoid colon: Case report and review of literature

Leiomyosarcomas of the sigmoid colon are aggressive and extremely rare tumors representing less than 0.1% of all colorectal malignancies. Few cases have been reported in the literature and their imaging features need to be more detailed. We report the case of a 70 year old male patient, smoker, with a history of arterial hypertension, admitted for abdominal pain and hypogastric mass. Computed tomography has shown a voluminous heterogeneously enhancing tumor process with a necrotic center, attached to the sigmoid wall, with multiple secondary peritoneal and hepatic masses. The anatomopathological examination of the biopsy sample with immunohistochemistry allowed the diagnosis of leiomyosarcoma of the sigmoid colon. Clinical presentation and radiological features of leiomyosarcomas are non-specific, and the definitive diagnosis is only established after an anatomopathological examination.