Surgical treatment of trochanteric fractures of the femur]

The authors present the results of studies of etiology of acute group intestinal diseases in neonates from whom escherichia of serological group 0128ac:K67 possessing the following characteristics were isolated: of the same (with the H12 antigen) serological and enzymatic type (nonfermenting sucrose and raffinose, fermenting dulcit and sorbit the first 24 hours, and slowly fermenting ramnose). All the cultures isolated were resistant to the majority of antibiotics used at present, and were only weakly sensitive to erythromycin. Difficulties (agglutination of live cultures with production sera in the absence of low agglutinability of heated cultures) in serological typing of the cultures were due to different partial O-antigen composition of the cultures isolated and of the production strain used in the preparation of commercial sera of the given serological group (0128ab:K67). Because circulation of escherichia of serological 0128ac variant was revealed in the USSR there occurred a necessity of their identification in practical laboratories; for this purpose organization of industrial production of the corresponding serum is necessary.     

Jones fracture. Surgical versus nonsurgical treatment

Sixty-three patients with 66 transverse and short oblique fractures of the proximal shaft of the fifth metatarsal bone (Jones fracture) were evaluated an average of five years (range, one to ten years) after the injury. There were 27 acute fractures and 39 chronic, or stress, fractures. The primary treatment was surgical for one third of the injuries and nonsurgical for the others. Surgical treatment consisted of the insertion of medullary screws. Nonsurgical treatment consisted of the application of either a plaster cast or an elastic bandage. Almost one fourth of the fractures treated nonsurgically later had to be treated surgically because of delayed unions or refractures. Late surgery was required in 12% of acute fractures and in 50% of chronic fractures with sclerosis narrowing the medullary canal. Irrespective of the primary treatment, all the patients had full function at the time of the follow-up evaluation, and no nonunions were diagnosed.     

锁定钢板内固定治疗股骨远端骨折42例临床分析

目的 探讨股骨远端骨折锁定钢板内固定治疗的临床方法及疗效分析.方法 回顾我院其中2004年4月～2009年7月股骨远端骨折42例,采用股骨远端锁定钢板内固定.结果 42例随访11个月～3年,平均18个月,骨折愈合40例,不愈合2例.膝关节功能按Karlstrom标准评价:优良率90.47%.结论 锁定钢板治疗股骨远端骨折,螺钉、钢板匹配相合,锁定在一起,互为一体,固定坚固,有利于骨折的愈合及软组织的修复,是目前众多治疗股骨远端骨折较为有效的方法之一.     

A mechanical comparison of subtrochanteric femur fracture fixation

The aim of this study was to compare in vitro diagnostic performance of three electrical methods for occlusal caries diagnosis with that of visual inspection and bite-wing radiography. One hundred and seven extracted molar and premolar teeth were subjected to the diagnostic methods by 2 operators and subsequently sectioned for histological validation. Electrical measurements were made at site level and at surface level using two different instruments. The diagnostic parameters calculated from the results were: sensitivity, specificity, diagnostic accuracy at a theoretical caries prevalence of 10% and area under the ROC curve. The electrical methods and bite-wing radiography showed higher sensitivity and lower specificity than visual inspection. Diagnostic accuracy was significantly lower for bite-wing radiography and one electrical method than for visual inspection. Overall diagnostic performance of two electrical methods was superior.     

Central (interior) osteophytes of the distal femur. Imaging and pathologic findings

RATIONALE AND OBJECTIVES: To characterize central osteophytes (COs) of the distal femur, imaging features that enable their differentiation from intra-articular bodies were identified, and the frequency of overlying articular cartilage abnormalities was determined. METHODS: The authors inspected 133 distal femoral specimens and retrospectively reviewed knee radiographs of 48 symptomatic patients and magnetic resonance images of 60 symptomatic patients for presence of COs. The location and imaging features of COs, and their association with marginal osteophytes (MOs), were recorded. Articular cartilage abnormalities, if any, were documented in patients who underwent magnetic resonance imaging. RESULTS: Specimen analysis showed a 41% prevalence of COs, 95% association of COs with MOs, and predominance of large COs in the medial femoral condyle (81%). Radiographic analysis revealed a 9.8% prevalence of COs in the distal femur. Magnetic resonance images demonstrated a 14.3% prevalence of COs, with the majority (73%) accompanied by an overlying cartilage that had abnormal signal intensity or morphology, or both. CONCLUSIONS: Central osteophytes are a common finding in the distal femur. Based on their location and cortical continuity with the underlying bone, most COs can be differentiated from intra-articular bodies.     

Surgical therapy of dens fracture

The use of Anderson/D'Alonso or Aebi/Nazarian classification of dens fractures is the basis for exact selection of therapy. The ventral screw-fixation of Anderson type-II-Fracture is today the common standard of treatment, especially in the elderly. The stabilisation of the fracture with maintenance of atlanto-axial rotation-function, the minimal rate of pseudarthrosis compared with conservative therapy, the minimal operation trauma and the immediate mobilisation with high patient comfort are decisive benefits of this method. Reposition of the fracture, visualisation in two planes and the use of adequate instruments are important conditions to get optimal operation results. In-vitro-experiments have shown that there is no difference of stability in one- or two-screw-technique. Flexion injuries with oblique fracture plane, insufficient stability after anterior screw fixation and typ-III-fractures are indications for dorsal, atlanto-axial screw fixation. The conservative treatment(HALO-vest) is recommended only in otherwise inoperable patients.     

Surgical management of acute tarsometatarsal fracture dislocation in the adult

Injuries to the tarsometatarsal joint involving fracture dislocations are uncommon and are often referred to as Lisfranc lesions after the French field surgeon in the Napoleonic Wars. Despite the infrequency of this serious injury, they have the potential for chronic disability and require prompt, accurate diagnosis and precise anatomic reduction to minimize long term disability. A review of the literature shows that opinions differ as to the most appropriate method of treatment for these injuries, be it closed or open reduction, but most authors agree that it is imperative to achieve precise anatomic reduction.     

Surgical treatment of the rheumatoid foot

The delomorphus cells of gastric mucosa in patients with liver cirrhosis and healthy subjects were investigated. They were counted according to Card and Marks method, their number being determined in 0,005 mm2 mucosa. In the patients with liver cirrhosis, corresponding to the stage of gastric mucosa alterations, a considerable decrease of the delomorphus cell number was established as compared with the healthy subjects. Succindehydrogenase activity in them is also decreased. Those data correlate with the hypo- and anacidity in patients with liver cirrhosis, observed and described at the clinic and come to confirm the correlation between the functional and structural state of gastric mucosa.     

Surgical treatment of the rheumatic neck

This paper reviews rheumatoid cervical spine disease with emphasis on surgical management. The rheumatoid process in the cervical spine is outlined, and the different clinical syndromes are explained according to the underlying pathology. Guidelines for the management of patients with this disease are suggested, and the indications for surgery are discussed. The different surgical approaches and techniques are briefly summarised.     

Surgical repair of fracture of the os penis in a dog

An eight-year-old male Australian cattle dog cross was presented with complete urethral obstruction secondary to fracture of the os penis which had occurred two years earlier. Obstruction was associated with callus and fibrous tissue proliferation compressing the urethra at the fracture site. The problem was satisfactorily resolved by removing excess bone and fibrous tissue and stabilising the fracture with a stainless steel finger plate.     

Effect on the femur of a new hip fracture preventive system using dropped-weight impact testing

To reduce hip fractures during falls, we devised a new hip fracture preventive system to attenuate impact on the greater trochanteric region and studied the effects of the system on the femur. Twelve coupled, embalmed, cadaveric femora were used. Right femora were fractured without protection as a control and compared with left femora covered by the protection system, which consisted of a silicone gel pad or the silicone gel pad combined with a resin cover. The impact of a fall was simulated by mounting a femur in the horizontal plane and dropping an 8.4 kg mass on its greater trochanteric region. The impact load and time were measured using a load cell within the mass. The maximum strain during impact at the inferior side of the femoral neck was determined from an attached strain gauge. Trochanteric fractures were produced in 18 of the 24 femora (75%). The mean impact load for a drop height of 25 cm was reduced from 3117 N to 2176 N by silicone gel (p < 0.01) and to 1681 N by the addition of the resin cover (p < 0.01). The mean maximum strain was similarly reduced from 2276 microvarepsilon to 1872 microvarepsilon (p = 0.15) and to a mean 1559 microvarepsilon (p < 0. 05). The mean impact time was prolonged from 13 ms to 20 ms (p < 0. 01) and 22 ms (p < 0.01), respectively. The effect of the cover became more conspicuous as height increased. We concluded that the silicone gel pad provided effective impact attenuation, and the addition of the rigid cover was even more effective for impact reduction. This system was thought to be clinically useful in preventing hip fractures.     

Surgical treatment of mesotympanitis

A chronic sluggish suppuration in the middle ear, mesotympanitis, leads to impairment of sound conduction and onset of hypoacusis. Otogenic labyrinthopathy is also possible. As to complications, present-day course of mesotympanitis is close to epitympanitis. Intensive conservative therapy should be followed by revision of the middle ear system earlier than 4-6 months of remission. In minor lesions tympanoplasty with retroauricular drainage of the antrum is indicated, in serious affection surgical intervention is needed.     

Our indications in surgical treatment of supra-condylar fractures of the femur

The treatment of supracondylar fractures of the femur should be surgical. The authors consider the requirements of a strict technic of osteosynthesis. The use for this purpose: either a plate and strip, or a plate and screw, and justify their respective indications.     

Surgical treatment of endocarditis

Since early investigators first suggested that the treatment of endocarditis should include valve replacement for infections not readily controlled with medical therapy alone, the role of surgery has become expanded, yet refined, to improve the outcome of patients with this potentially fatal disease. Innovative surgical techniques have also been developed in an effort to improve the results of surgical treatment for complex sequelae of invasive infections. This article examines the current indications for surgical intervention, compares the various surgical options, and assesses the expected short-and long-term outcome after valve replacement for patients with native valve or prosthetic valve endocarditis.