H. Winkler

Die ProFI-Reposition der Pronatio dolorosa infantum

BACKGROUND Pulled elbow is a common injury in children under the age of 5 years which is usually treated by manual reduction. Supination of the forearm is recommended as opposed to pronation or other maneuvers. The author has developed a manipulative intervention for reduction of pulled elbow in young children on the basis of the pronation technique and called ProFI reduction. PATIENTS AND METHODS The ProFI method was performed on 41 children and the group was analyzed prospectively according to effectiveness of the ProFI repositioning. RESULTS Among the 41 children the initial diagnosis was incorrect in 7 cases (17%) and in 11 children (27%) more than one doctors visit was necessary to reposition successfully. Repositioning with the ProFI method was immediately successful in all cases. CONCLUSION The application of the ProFI method as a modified pronation technique was shown to provide excellent effectiveness with respect to the patients treated.

Posterozentraler Zugang zum dorsalen Tibiakopf

BACKGROUND For surgical treatment of posterior shearing tibial plateau fractures and avulsion fractures of the posterior cruciate ligament (PCL) a posterocentral approach without dissection or separation of the heads of the gastrocnemius muscle is used. The aim of this study was an evaluation of this approach. PATIENTS AND METHODS From 2001-2012 a total of 33 patients were surgically treated using a posterocentral approach to the dorsal knee joint. Of these patients 22 had a posterior shearing tibial plateau fracture and 11 had an avulsion fracture of the PCL. The fracture type, complications, expertise of the surgeon, fracture healing, implant position and irritation, nerve lesions, scar tissue and range of motion were documented. RESULTS Hypesthesia around the scar, at the lateral foot and lower lateral leg were observed in one each of three patients. Despite two ventral implant infections no infection of the dorsal implant occurred. All scar tissue was without pathological findings and scar contracture was not observed. In three cases the screw tips at the anterior proximal tibia were palpable but without complaints from the patients. CONCLUSIONS The posterocentral approach showed a low complication rate in the hands of experienced surgeons. The soft tissue cover seems to prevent implant infections.

Notfallröntgen bei verletzten Kindern und Jugendlichen

BACKGROUND Adequate interpretation of radiographs of injured children and adolescents is key for appropriate treatment. For the purposes of structuring in-hospital education and training, conventional radiographs obtained in the emergency department (ED) should be analyzed. MATERIAL AND METHODS A total of 10,232 radiographs of children and adolescents (0-17 years old) were analyzed retrospectively. Data was analyzed according to sex, age, time, radiograph, and type of insurance. RESULTS The male to female ratio was 3:2. In all, 76% of all radiographs were processed during on-call duty hours. Radiographs of the ankle were ordered most at a rate of 11%. Radiographs of the skull, wrist, finger, and ankle stood out from the sum of all radiographs and together accounted for 40%. CONCLUSION Radiographs of injured children are analyzed predominantly during on-call duty hours. Frequently mandated radiographs should be diagnosed accurately and standard injuries should be well known. Particular attention should be directed to the typical injury patterns of the ankle joint.

Einflussfaktoren auf den stationären Verlauf von Patienten mit hüftgelenknahen Femurfrakturen

BACKGROUND Time of surgery, age, sex, and co-morbidities influence the complication and mortality rate in patients with hip fractures. Patients with relevant co-morbidities, who were hospitalized at the weekend have a higher mortality rate. Complications prolong length of stay (LOS), which results in higher costs and shortage of bed capacity. OBJECTIVES The influence of various factors on hospitalization with emphasis on complications, LOS, and clinical mortality should be observed. MATERIALS AND METHODS Retrospectively, 242 patients with hip fractures (>64a) were observed. In addition to age and sex, time of hospitalization and surgery, intensive care therapy, hospital mortality, LOS, comorbidities, ASA, and complications were recorded. Times were assigned to the work week or the weekend or regular or on-call duty service. RESULTS 29.8 % were hospitalized at the weekend, 66.1% on on-call duty, 24.1% were operated on the weekend, 67.4% on on-call duty. 86.3% were operated <48 h after admission. The mortality rate was 8.3%. Longer time to surgery results in more frequent intensive care therapy, prolongs the LOS, and increases overall complications. Advanced age increases mortality and LOS. A higher value of the ASA classification leads to increased mortality; co-morbidities lead to more frequent intensive care therapy. Surgical complications prolong LOS of 10.8d (86.4%). CONCLUSION Hospitalization is influenced by age, ASA and co-morbidities as well as by time to surgery and operation in day or late and nighttime service. Early surgery and prevention of surgical complications reduce LOS.

Posterocentral approach to the posterior tibial plateau. Reconstruction of tibial plateau fractures and avulsions of the posterior cruciate ligament

BACKGROUND For surgical treatment of posterior shearing tibial plateau fractures and avulsion fractures of the posterior cruciate ligament (PCL) a posterocentral approach without dissection or separation of the heads of the gastrocnemius muscle is used. The aim of this study was an evaluation of this approach. PATIENTS AND METHODS From 2001-2012 a total of 33 patients were surgically treated using a posterocentral approach to the dorsal knee joint. Of these patients 22 had a posterior shearing tibial plateau fracture and 11 had an avulsion fracture of the PCL. The fracture type, complications, expertise of the surgeon, fracture healing, implant position and irritation, nerve lesions, scar tissue and range of motion were documented. RESULTS Hypesthesia around the scar, at the lateral foot and lower lateral leg were observed in one each of three patients. Despite two ventral implant infections no infection of the dorsal implant occurred. All scar tissue was without pathological findings and scar contracture was not observed. In three cases the screw tips at the anterior proximal tibia were palpable but without complaints from the patients. CONCLUSIONS The posterocentral approach showed a low complication rate in the hands of experienced surgeons. The soft tissue cover seems to prevent implant infections.

Triplane Fracture of the Distal Fibula

This is a case report of a 14-year-old girl with a triplane fracture of the distal fibula. The fracture showed displacement and was treated by open reduction, internal fixation, and 5 weeks of external immobilization. The follow-up 5 months after injury yielded an excellent clinical result. Triplane fractures are also seen in locations other than the growth plate of the distal tibia. Due to the occurrence close to the end of the growth period, the potential for growth deformity is negligible. There has been no previous report of a transitional fracture in this location.

[Factors influencing course of hospitalization in patients with hip fractures: Complications, length of stay and hospital mortality].

BACKGROUND Time of surgery, age, sex, and co-morbidities influence the complication and mortality rate in patients with hip fractures. Patients with relevant co-morbidities, who were hospitalized at the weekend have a higher mortality rate. Complications prolong length of stay (LOS), which results in higher costs and shortage of bed capacity. OBJECTIVES The influence of various factors on hospitalization with emphasis on complications, LOS, and clinical mortality should be observed. MATERIALS AND METHODS Retrospectively, 242 patients with hip fractures (>64a) were observed. In addition to age and sex, time of hospitalization and surgery, intensive care therapy, hospital mortality, LOS, comorbidities, ASA, and complications were recorded. Times were assigned to the work week or the weekend or regular or on-call duty service. RESULTS 29.8 % were hospitalized at the weekend, 66.1% on on-call duty, 24.1% were operated on the weekend, 67.4% on on-call duty. 86.3% were operated <48 h after admission. The mortality rate was 8.3%. Longer time to surgery results in more frequent intensive care therapy, prolongs the LOS, and increases overall complications. Advanced age increases mortality and LOS. A higher value of the ASA classification leads to increased mortality; co-morbidities lead to more frequent intensive care therapy. Surgical complications prolong LOS of 10.8d (86.4%). CONCLUSION Hospitalization is influenced by age, ASA and co-morbidities as well as by time to surgery and operation in day or late and nighttime service. Early surgery and prevention of surgical complications reduce LOS.

ProFI reduction of pediatric pulled elbow

BACKGROUND Pulled elbow is a common injury in children under the age of 5 years which is usually treated by manual reduction. Supination of the forearm is recommended as opposed to pronation or other maneuvers. The author has developed a manipulative intervention for reduction of pulled elbow in young children on the basis of the pronation technique and called ProFI reduction. PATIENTS AND METHODS The ProFI method was performed on 41 children and the group was analyzed prospectively according to effectiveness of the ProFI repositioning. RESULTS Among the 41 children the initial diagnosis was incorrect in 7 cases (17%) and in 11 children (27%) more than one doctors visit was necessary to reposition successfully. Repositioning with the ProFI method was immediately successful in all cases. CONCLUSION The application of the ProFI method as a modified pronation technique was shown to provide excellent effectiveness with respect to the patients treated.

Verweildauer von Patienten mit hüftgelenknahen Femurfrakturen

BACKGROUND In departments of orthopedic and trauma surgery patients with proximal femoral fractures constitute the largest proportion of trauma patients. The length of stay (LOS) has economic consequences and prolonged LOS leads to a shortage in bed capacity. OBJECTIVES In this study treatment and patient-related factors that influence the LOS of patients with proximal femoral fractures were investigated. MATERIAL AND METHODS Treatment and patient-related data of 242 patients (age >64 years) were recorded retrospectively and included residential aspects, legal guardianship, time of admission and surgery, hospital mortality, LOS, diagnosis, comorbidities, medication, surgical treatment, general and surgical complications, intensive care therapy and American Society of Anesthesiologists (ASA) classification. RESULTS Of the patients, one fifth came from a nursing home and were under supervised care or a healthcare proxy at the time of admission. Two thirds were admitted to hospital and operated on during on-call service periods. One half of the patients did not return to their previous domestic environment and were usually admitted to a nursing home. Patients who came from or were admitted to nursing homes, who were under healthcare supervision as well as patients who rapidly underwent surgery had a shorter LOS. Hospitalization and surgery during on-call service periods did not extend the LOS and showed a tendency towards reduction. Older age correlated with a longer LOS and surgical complications doubled the LOS. DISCUSSION Surgical treatment during on-call service periods, short preoperative waiting times and avoidance of surgical complications shortened LOS and thus had an impact on costs and bed capacity.

Traumatische Apophysenlösung des Trochanter minor

ZusammenfassungBei der traumatischen Apophysenlösung des Trochanter minor handelt es sich um eine sehr seltene Verletzung, welche häufig als Hüftzerrung oder Muskelfaserriss fehlinterpretiert wird. Wir berichten über einen 13-jährigen Jungen, der sich beim Anlauf zum Weitsprung eine traumatische Apophysenlösung des Trochanter minor zuzog. Unter konservativer Therapie konnte der Junge nach 12 Wochen seine sportlichen Aktivitäten wieder aufnehmen.AbstractAn avulsion fracture of the lesser trochanter is a very rare injury often misdiagnosed as a muscle lesion or hip distortion. This report concerns the avulsion fracture of the lesser trochanter of a 13-year-old boy, suffered on a runway preparing for a long jump. Conservative treatment without weight-bearing was indicated for 6 weeks. Twelve weeks after the injury the patient resumed his normal sport activities.An avulsion fracture of the lesser trochanter is a very rare injury often misdiagnosed as a muscle lesion or hip distortion. This report concerns the avulsion fracture of the lesser trochanter of a 13-year-old boy, suffered on a runway preparing for a long jump. Conservative treatment without weight-bearing was indicated for 6 weeks. Twelve weeks after the injury the patient resumed his normal sport activities.