This is a clinical and radiological follow-up on 78 patients with 84 Pilon tibial-fractures which... more This is a clinical and radiological follow-up on 78 patients with 84 Pilon tibial-fractures which were treated in our hospital between 1970-82. The fractures were arranged in three types after the classification of Rüedi, Matter, Allgöwer. 49 conservatively treated fractures were compared with 35 cases operated upon. The radiological follow-up focussed on posttraumatic development of arthrosis, the mobility of the ankle as well as on the posttraumatic result of reduction. The patient's own assessment concerning the result was found out by means of a questionnaire. The comparison of the fracture type I and II showed almost the same development of arthrosis after conservative and operative treatment, but the operated fractures of type III resulted in 33% in heavy arthrosis, whereas the cases treated conservatively showed heavy arthrosis in 50%. A close correlation exists between the quality of operative reduction and the development of arthrosis. A postoperative incongruity of the articular surface is followed by heavier arthrosis than a comparable incongruity after conservative treatment. An indication of an open reduction is given only if anatomical reconstruction can be predicted.
Clinical and radiological examination was done in 61 patients in whom a Bankart procedure had bee... more Clinical and radiological examination was done in 61 patients in whom a Bankart procedure had been performed. In an X-ray follow-up the value of different techniques proving the Hill-Sachs-lesion and degenerative changes of the bony glenoid rim, as described in literature, was investigated. Eight X-rays were performed in each patient. Most of the Hill-Sachs-lesions (76%) were found by internal rotation of 60 degrees in a.p. direction. A three dimensional idea can be obtained by an additional X-ray in tangential projection. Degenerative changes of the bony glenoid rim were found by the Bernageau technique in 25 percent. Standard X-ray before operation should include techniques in various projections: a.p. and simultaneous internal rotation of 60 degrees of both sides, tangential projection, and X-ray as described by Bernageau.
This is a clinical and radiological follow-up on 61 patients operated upon between 1973 and 1983 ... more This is a clinical and radiological follow-up on 61 patients operated upon between 1973 and 1983 according to the Bankart technique. In 84 per cent of all cases primary dislocation had taken place before the age of thirty. On an average 11 recurrent dislocations occurred before the operative procedure was performed. The radiological follow-up comprised X-rays in a.p. position with internal rotation of 60 degrees, in tangent plane according to Hermodsson as well as in dorsal tangent plane. In the modified score of Caroit and Cyprien 34 operations had excellent, 25 good, 2 moderate and 2 poor results (recurrent postoperative dislocation and deep infection). Neglecting those cases with severe deformation of the glenoid one can state that the Bankart technique offers fair results in the treatment of recurrent dislocation of the shoulder.
Neuropsychological performance, magnetic resonance imaging (MRI) and electroencephalography (EEG)... more Neuropsychological performance, magnetic resonance imaging (MRI) and electroencephalography (EEG) were investigated in 12 consecutive patients with very mild traumatic brain injury (MTBI) (Glasgow coma score 15) within 24 hours and 6 weeks after injury. The data were compared to 14 control subjects. There was a significant impairment in neuropsychological performance (verbal memory, arithmetic abilities and psychomotor reaction time) at onset and after 6 weeks, whereas verbal fluency and non-verbal memory test revealed no significant differences matching the control values. In MRI scans, three patients showed traumatic lesions (slight epidural haematoma, haemorrhagic contusions and white matter lesions indicating diffuse axonal injury). In the EEG recordings, no generalized slowing or focal changes were found. Structural and functional impairment can be identified using neuroimaging and neuropsychological examination, even in very MTBI patients.
In total, more than 2000 injured recreational skiers and snowboarders were interviewed during the... more In total, more than 2000 injured recreational skiers and snowboarders were interviewed during the 2011/2012 winter season in the Austrian province Vorarlberg about self-reported risk taking (more cautious vs. more risky), ski helmet use, and accident causes (self-inflicted fall vs. collision with another person vs. collision with an object vs. others). Accident causes were binary coded and to evaluate differences in frequencies according to selfreported risk taking behaviour, chi-square-tests were performed.
Background: Due to the topography and skiing tradition, Austria is a popular country for winter s... more Background: Due to the topography and skiing tradition, Austria is a popular country for winter sports enjoyed by locals and tourists. Methods: Between December 2011 and April 2012, a total of 860 guests were injured on ski slopes in the Austrian province Vorarlberg during their holidays and 801 injured locals have been interviewed with regard to causes of accidents and potential risk factors. Results: In total, 33% of guests get injured on their first day and 24% on their second day on ski slopes, respectively. Although guests and locals did not differ with regard to the cause of accident (84% self-inflicted fall, 7% collisions with another person), guests suffered more often from bone fractures (43 vs. 34%) and concussions (11 vs. 4%). The proportion of less skilled people (31 vs. 19%) was higher among guests. In contrast, locals indicated to ski more often > 14 days per season (61 vs. 20%) and rated their behaviour on ski slopes more frequently as risky (34 vs. 17%). Furthermo...
5 hospitals with an emergency department of a Western Austrian province. We recorded binding rele... more 5 hospitals with an emergency department of a Western Austrian province. We recorded binding release at the moment of the accident, the date of the last binding adjustment (this season, last season, before) and injured body part. Differences in frequencies were evaluated by chi-square-tests.
ABSTRACT BACKGROUND: Infection of alloplastic material is usually caused by staphylococci. Entero... more ABSTRACT BACKGROUND: Infection of alloplastic material is usually caused by staphylococci. Enterococci rarely have been implicated in infections after osteosynthesis. Enterococcus faecium is resistant to most antibiotics with glycopeptides being considered the treatment of choice. METHODS: We describe the case of a 41-year-old male, who sustained a trauma during a working accident with multiple open fractures of the right femur, tibia, food and toes. RESULTS: Initial treatment included stabilizing the fractures using external fixation and debridement of wounds with the application of a vacuum assisted device. On the third day post trauma, the fracture was stabilized by osteosynthesis with LISS lateral and of the median condyle. Repeatedly, soft tissue necroses were debrided and the VAC-system changed and after four weeks the skin was covered with a MESH graft. During the seventh week the patient got a fracture of the LISS and a new system had to be implanted. Enterococcus faecium was isolated and treatment was started with Vancomycin. The patient underwent another two surgical interventions with debridement of necroses and implantation of autologous spongiosa and BMP 7. External fixation was removed and moderate mechanical stress was tolerated. Antibiotic therapy was switched to oral linezolid for another six weeks. Nine weeks later, CT scan showed a regenerated femur and ankle joint. Six months following the complicated trauma, the patient was able to walk again. CONCLUSIONS: Multimodal approach with stepwise reconstruction of the severely traumatized tissue allowed recovery from this injury with a good functional result. Linezolid proved useful in the oral therapy of this severe enterococcal infection. GRUNDLAGEN: Infektionen von alloplastischem Material werden meist durch Staphylokokken verursacht. Enterokokken sind selten Auslöser von Infektionen nach osteosynthetischen Verfahren. Enterococcus faecium ist gegen viele Antibiotika resistent; Glycopeptide sind Mittel der Wahl. METHODIK: Wir berichten über einen 41-jährigen Mann, welcher im Rahmen eines Arbeitsunfalls eine drittgradig offene Quetschverletzung mit Kettenfrakturen des rechten Femurschaftes, medialen Femurkondylen, der distalen Tibia, des Mittelfußes und der Zehen erlitt. ERGEBNISSE: Die Erstversorgung umfasste das Stabilisieren der Brüche mittels Fixateur externe, Fasziotomie und Debridement der Wunden und Applikation eines VAC-Systems. Am dritten posttraumatischen Tag wurde der Oberschenkelbruch osteosynthetisch durch eine LISS-Platte versorgt. Erneut wurden Gewebsnekrosen debridiert und das VAC-System gewechselt. Nach vier Wochen wurde die Haut mit einem Meshgraft-Autotransplantat gedeckt. Während der siebenten Woche kam es zu einem Ausriss der LISS-Platte, und ein neues System musste implantiert werden. Aus nekrotischem Gewebe im Bereich der Ausrissstelle wurde Enterococcus faecium isoliert. Eine Behandlung mit intravenösem Vancomycin wurde begonnen. Der Patient musste sich zwei weiteren chirurgischen Eingriffen mit Debridement von Nekrosen und Implantation von autologer Spongiosa und BMP 7 unterziehen. Die antibiotische Therapie wurde mit Linezolid p.o. für weitere sechs Wochen fortgeführt. Der Fixateur externe konnte entfernt werden und der Patient tolerierte moderate mechanische Belastung gut. Nach neun Wochen zeigten Röntgen und CT einen weitgehend regenerierten Oberschenkelknochen und ein gutes Ergebnis im Bereich des Sprunggelenkes. Sechs Monate im Anschluss an das komplizierte Trauma war der Patient wieder im Stande, ohne Hilfe zu gehen, und es gab keinen Hinweis für eine Neuinfektion. SCHLUSSFOLGERUNGEN: Die multimodale Vorgehensweise mit schrittweiser Rekonstruktion der schweren Weichteilschädigung als auch der knöchernen Verletzungen erlaubte eine Wiederherstellung mit einem guten funktionellen und kosmetischem Ergebnis. Linezolid erwies sich als effektives Antibiotikum in der oralen Therapie dieser schweren Enterokokkeninfektion.
The aim of the present study is to investigate the growth of the tibia after femoral shaft fractu... more The aim of the present study is to investigate the growth of the tibia after femoral shaft fractures in children. We were able to follow up 44 patients (32 male and 12 female) after a mean of 8 years (range, 5 to 15 years). The age in the time of injury was 3 till 13 years (mean 7 years). The length of the femur, tibia and leg was measured on X-rays of the entire leg, and the measurements were compared with the contralateral side. A statistically significant number of tibial elongations were observed in fractures that had healed in considerable malalignment (at least 1 cm shortening, dislocation of at least a half of the breadth of the femoral shaft, angular deformity of more than 10 degrees) (p = 0.003) and in fractures that were subjected to manipulation (secondary reduction, change of treatment or traction weight) during the healing process (p = 0.007). Furthermore, all 7 patients who had infection requiring treatment at the tibial plateau extension had more pronounced tibial gro...
Universit~itsklinik ftir Unfallchirurgie Innsbmck (Vorstand i.V.: Univ.-Doz. Dr. L. J. Lugger) 61... more Universit~itsklinik ftir Unfallchirurgie Innsbmck (Vorstand i.V.: Univ.-Doz. Dr. L. J. Lugger) 61 Patienten, die im Zeitraum 1973 bis 1983 wegen habitueller Schulterluxation in der Technik nach Bankart operie rt worden waren, wurden klinisch und radiologisch nachuntersucht. Bei der R6ntgenuntersuchung wurde die Wertigkeit einzeiner in der Literatur beschriebener Aufnahmetechniken zum Nachweis der Hill-Sachs-L/ision sowie kn6chemerVer~indemngen am vorderen Pfannenrand gepriift. Insgesamt gelangten acht R6ntgenbilder pro Patient zur Auswertung, wobei mit der anteroposterioren 60-Grad-Innenrotationsaufnahme der Nachweis des ,,typischen Defektes" in 76'3/0 am h/iufigsten gelang. Eine rg.umliche Vorstellung vonder L/isio n erh~ilt man mit einer zus~itzlichen dorsalen Tangentialaufnahme. Kn{Scherne Ver~indemngen am vorderen unteren Pfannenrand konnten mit der von Bemageau angegebenen Technik in 25 % de r F~ille nachgewiesen werden. Somit sollte ein pr~ioperativer R6ntgenstatus eine anteroposteriore 60-Grad-Innenrotationsaufnahme im Seitenvergleich, eine dorsale Tangentialaufnahme und eine Pfannenprofilaufnahme nach Bernageau enthalten.
Zusammenfassung GRUNDLAGEN: Infektionen von alloplastischem Material werden meist durch Staphylo... more Zusammenfassung GRUNDLAGEN: Infektionen von alloplastischem Material werden meist durch Staphylokokken verursacht. Enterokokken sind selten Auslöser von Infektionen nach osteosynthetischen Verfahren. Enterococcus faecium ist gegen viele Antibiotika resistent; Glycopeptide sind Mittel der Wahl. METHODIK: Wir berichten über einen 41-jährigen Mann, welcher im Rahmen eines Arbeitsunfalls eine drittgradig offene Quetschverletzung mit Kettenfrakturen des rechten Femurschaftes, medialen Femurkondylen, der distalen Tibia, des Mittelfußes und
This is a clinical and radiological follow-up on 78 patients with 84 Pilon tibial-fractures which... more This is a clinical and radiological follow-up on 78 patients with 84 Pilon tibial-fractures which were treated in our hospital between 1970-82. The fractures were arranged in three types after the classification of Rüedi, Matter, Allgöwer. 49 conservatively treated fractures were compared with 35 cases operated upon. The radiological follow-up focussed on posttraumatic development of arthrosis, the mobility of the ankle as well as on the posttraumatic result of reduction. The patient's own assessment concerning the result was found out by means of a questionnaire. The comparison of the fracture type I and II showed almost the same development of arthrosis after conservative and operative treatment, but the operated fractures of type III resulted in 33% in heavy arthrosis, whereas the cases treated conservatively showed heavy arthrosis in 50%. A close correlation exists between the quality of operative reduction and the development of arthrosis. A postoperative incongruity of the articular surface is followed by heavier arthrosis than a comparable incongruity after conservative treatment. An indication of an open reduction is given only if anatomical reconstruction can be predicted.
Clinical and radiological examination was done in 61 patients in whom a Bankart procedure had bee... more Clinical and radiological examination was done in 61 patients in whom a Bankart procedure had been performed. In an X-ray follow-up the value of different techniques proving the Hill-Sachs-lesion and degenerative changes of the bony glenoid rim, as described in literature, was investigated. Eight X-rays were performed in each patient. Most of the Hill-Sachs-lesions (76%) were found by internal rotation of 60 degrees in a.p. direction. A three dimensional idea can be obtained by an additional X-ray in tangential projection. Degenerative changes of the bony glenoid rim were found by the Bernageau technique in 25 percent. Standard X-ray before operation should include techniques in various projections: a.p. and simultaneous internal rotation of 60 degrees of both sides, tangential projection, and X-ray as described by Bernageau.
This is a clinical and radiological follow-up on 61 patients operated upon between 1973 and 1983 ... more This is a clinical and radiological follow-up on 61 patients operated upon between 1973 and 1983 according to the Bankart technique. In 84 per cent of all cases primary dislocation had taken place before the age of thirty. On an average 11 recurrent dislocations occurred before the operative procedure was performed. The radiological follow-up comprised X-rays in a.p. position with internal rotation of 60 degrees, in tangent plane according to Hermodsson as well as in dorsal tangent plane. In the modified score of Caroit and Cyprien 34 operations had excellent, 25 good, 2 moderate and 2 poor results (recurrent postoperative dislocation and deep infection). Neglecting those cases with severe deformation of the glenoid one can state that the Bankart technique offers fair results in the treatment of recurrent dislocation of the shoulder.
Neuropsychological performance, magnetic resonance imaging (MRI) and electroencephalography (EEG)... more Neuropsychological performance, magnetic resonance imaging (MRI) and electroencephalography (EEG) were investigated in 12 consecutive patients with very mild traumatic brain injury (MTBI) (Glasgow coma score 15) within 24 hours and 6 weeks after injury. The data were compared to 14 control subjects. There was a significant impairment in neuropsychological performance (verbal memory, arithmetic abilities and psychomotor reaction time) at onset and after 6 weeks, whereas verbal fluency and non-verbal memory test revealed no significant differences matching the control values. In MRI scans, three patients showed traumatic lesions (slight epidural haematoma, haemorrhagic contusions and white matter lesions indicating diffuse axonal injury). In the EEG recordings, no generalized slowing or focal changes were found. Structural and functional impairment can be identified using neuroimaging and neuropsychological examination, even in very MTBI patients.
In total, more than 2000 injured recreational skiers and snowboarders were interviewed during the... more In total, more than 2000 injured recreational skiers and snowboarders were interviewed during the 2011/2012 winter season in the Austrian province Vorarlberg about self-reported risk taking (more cautious vs. more risky), ski helmet use, and accident causes (self-inflicted fall vs. collision with another person vs. collision with an object vs. others). Accident causes were binary coded and to evaluate differences in frequencies according to selfreported risk taking behaviour, chi-square-tests were performed.
Background: Due to the topography and skiing tradition, Austria is a popular country for winter s... more Background: Due to the topography and skiing tradition, Austria is a popular country for winter sports enjoyed by locals and tourists. Methods: Between December 2011 and April 2012, a total of 860 guests were injured on ski slopes in the Austrian province Vorarlberg during their holidays and 801 injured locals have been interviewed with regard to causes of accidents and potential risk factors. Results: In total, 33% of guests get injured on their first day and 24% on their second day on ski slopes, respectively. Although guests and locals did not differ with regard to the cause of accident (84% self-inflicted fall, 7% collisions with another person), guests suffered more often from bone fractures (43 vs. 34%) and concussions (11 vs. 4%). The proportion of less skilled people (31 vs. 19%) was higher among guests. In contrast, locals indicated to ski more often > 14 days per season (61 vs. 20%) and rated their behaviour on ski slopes more frequently as risky (34 vs. 17%). Furthermo...
5 hospitals with an emergency department of a Western Austrian province. We recorded binding rele... more 5 hospitals with an emergency department of a Western Austrian province. We recorded binding release at the moment of the accident, the date of the last binding adjustment (this season, last season, before) and injured body part. Differences in frequencies were evaluated by chi-square-tests.
ABSTRACT BACKGROUND: Infection of alloplastic material is usually caused by staphylococci. Entero... more ABSTRACT BACKGROUND: Infection of alloplastic material is usually caused by staphylococci. Enterococci rarely have been implicated in infections after osteosynthesis. Enterococcus faecium is resistant to most antibiotics with glycopeptides being considered the treatment of choice. METHODS: We describe the case of a 41-year-old male, who sustained a trauma during a working accident with multiple open fractures of the right femur, tibia, food and toes. RESULTS: Initial treatment included stabilizing the fractures using external fixation and debridement of wounds with the application of a vacuum assisted device. On the third day post trauma, the fracture was stabilized by osteosynthesis with LISS lateral and of the median condyle. Repeatedly, soft tissue necroses were debrided and the VAC-system changed and after four weeks the skin was covered with a MESH graft. During the seventh week the patient got a fracture of the LISS and a new system had to be implanted. Enterococcus faecium was isolated and treatment was started with Vancomycin. The patient underwent another two surgical interventions with debridement of necroses and implantation of autologous spongiosa and BMP 7. External fixation was removed and moderate mechanical stress was tolerated. Antibiotic therapy was switched to oral linezolid for another six weeks. Nine weeks later, CT scan showed a regenerated femur and ankle joint. Six months following the complicated trauma, the patient was able to walk again. CONCLUSIONS: Multimodal approach with stepwise reconstruction of the severely traumatized tissue allowed recovery from this injury with a good functional result. Linezolid proved useful in the oral therapy of this severe enterococcal infection. GRUNDLAGEN: Infektionen von alloplastischem Material werden meist durch Staphylokokken verursacht. Enterokokken sind selten Auslöser von Infektionen nach osteosynthetischen Verfahren. Enterococcus faecium ist gegen viele Antibiotika resistent; Glycopeptide sind Mittel der Wahl. METHODIK: Wir berichten über einen 41-jährigen Mann, welcher im Rahmen eines Arbeitsunfalls eine drittgradig offene Quetschverletzung mit Kettenfrakturen des rechten Femurschaftes, medialen Femurkondylen, der distalen Tibia, des Mittelfußes und der Zehen erlitt. ERGEBNISSE: Die Erstversorgung umfasste das Stabilisieren der Brüche mittels Fixateur externe, Fasziotomie und Debridement der Wunden und Applikation eines VAC-Systems. Am dritten posttraumatischen Tag wurde der Oberschenkelbruch osteosynthetisch durch eine LISS-Platte versorgt. Erneut wurden Gewebsnekrosen debridiert und das VAC-System gewechselt. Nach vier Wochen wurde die Haut mit einem Meshgraft-Autotransplantat gedeckt. Während der siebenten Woche kam es zu einem Ausriss der LISS-Platte, und ein neues System musste implantiert werden. Aus nekrotischem Gewebe im Bereich der Ausrissstelle wurde Enterococcus faecium isoliert. Eine Behandlung mit intravenösem Vancomycin wurde begonnen. Der Patient musste sich zwei weiteren chirurgischen Eingriffen mit Debridement von Nekrosen und Implantation von autologer Spongiosa und BMP 7 unterziehen. Die antibiotische Therapie wurde mit Linezolid p.o. für weitere sechs Wochen fortgeführt. Der Fixateur externe konnte entfernt werden und der Patient tolerierte moderate mechanische Belastung gut. Nach neun Wochen zeigten Röntgen und CT einen weitgehend regenerierten Oberschenkelknochen und ein gutes Ergebnis im Bereich des Sprunggelenkes. Sechs Monate im Anschluss an das komplizierte Trauma war der Patient wieder im Stande, ohne Hilfe zu gehen, und es gab keinen Hinweis für eine Neuinfektion. SCHLUSSFOLGERUNGEN: Die multimodale Vorgehensweise mit schrittweiser Rekonstruktion der schweren Weichteilschädigung als auch der knöchernen Verletzungen erlaubte eine Wiederherstellung mit einem guten funktionellen und kosmetischem Ergebnis. Linezolid erwies sich als effektives Antibiotikum in der oralen Therapie dieser schweren Enterokokkeninfektion.
The aim of the present study is to investigate the growth of the tibia after femoral shaft fractu... more The aim of the present study is to investigate the growth of the tibia after femoral shaft fractures in children. We were able to follow up 44 patients (32 male and 12 female) after a mean of 8 years (range, 5 to 15 years). The age in the time of injury was 3 till 13 years (mean 7 years). The length of the femur, tibia and leg was measured on X-rays of the entire leg, and the measurements were compared with the contralateral side. A statistically significant number of tibial elongations were observed in fractures that had healed in considerable malalignment (at least 1 cm shortening, dislocation of at least a half of the breadth of the femoral shaft, angular deformity of more than 10 degrees) (p = 0.003) and in fractures that were subjected to manipulation (secondary reduction, change of treatment or traction weight) during the healing process (p = 0.007). Furthermore, all 7 patients who had infection requiring treatment at the tibial plateau extension had more pronounced tibial gro...
Universit~itsklinik ftir Unfallchirurgie Innsbmck (Vorstand i.V.: Univ.-Doz. Dr. L. J. Lugger) 61... more Universit~itsklinik ftir Unfallchirurgie Innsbmck (Vorstand i.V.: Univ.-Doz. Dr. L. J. Lugger) 61 Patienten, die im Zeitraum 1973 bis 1983 wegen habitueller Schulterluxation in der Technik nach Bankart operie rt worden waren, wurden klinisch und radiologisch nachuntersucht. Bei der R6ntgenuntersuchung wurde die Wertigkeit einzeiner in der Literatur beschriebener Aufnahmetechniken zum Nachweis der Hill-Sachs-L/ision sowie kn6chemerVer~indemngen am vorderen Pfannenrand gepriift. Insgesamt gelangten acht R6ntgenbilder pro Patient zur Auswertung, wobei mit der anteroposterioren 60-Grad-Innenrotationsaufnahme der Nachweis des ,,typischen Defektes" in 76'3/0 am h/iufigsten gelang. Eine rg.umliche Vorstellung vonder L/isio n erh~ilt man mit einer zus~itzlichen dorsalen Tangentialaufnahme. Kn{Scherne Ver~indemngen am vorderen unteren Pfannenrand konnten mit der von Bemageau angegebenen Technik in 25 % de r F~ille nachgewiesen werden. Somit sollte ein pr~ioperativer R6ntgenstatus eine anteroposteriore 60-Grad-Innenrotationsaufnahme im Seitenvergleich, eine dorsale Tangentialaufnahme und eine Pfannenprofilaufnahme nach Bernageau enthalten.
Zusammenfassung GRUNDLAGEN: Infektionen von alloplastischem Material werden meist durch Staphylo... more Zusammenfassung GRUNDLAGEN: Infektionen von alloplastischem Material werden meist durch Staphylokokken verursacht. Enterokokken sind selten Auslöser von Infektionen nach osteosynthetischen Verfahren. Enterococcus faecium ist gegen viele Antibiotika resistent; Glycopeptide sind Mittel der Wahl. METHODIK: Wir berichten über einen 41-jährigen Mann, welcher im Rahmen eines Arbeitsunfalls eine drittgradig offene Quetschverletzung mit Kettenfrakturen des rechten Femurschaftes, medialen Femurkondylen, der distalen Tibia, des Mittelfußes und
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