Abstracts - Chirurgie Kongress

Till abstract submission, 18 FDR were treated with this implant by two experienced trauma surgeons
within a time period of 12 weeks.
Following surgery, early functional postoperative treatment was encouraged in all patients. All patients
underwent x-ray evaluation and a clinical assessment 6 weeks postoperatively.
Evaluation also includes an analysis of potential advantages and pitfalls of the VA-LCP.
Results: So far, we have included a total of 18 patients (mean age 68 years, range 37-86 years) with 7
extra- and 11 intra-articular FDR (AO fracture classification: 7 A3-, 3 C1-, 6 C2- and 2 C3 fractures).
In our preliminary experience, the VA-LCP and its implant-specific instruments are easy to use without
major problems. Fracture fixation is reliable providing enough stability to allow early functional postoperative
treatment in all fracture patterns. We have encountered no implant-related complications and
signs of osseous consolidation were evident in all patients after 6 weeks.
Compared with the uninjured contra-lateral wrist, average range of motion reached 66% at follow-up
(ROM wrist: Flexion 68%; extension 56%, radial abduction 61%, ulnar abduction 63%, pronation 85%,
supination 66%).
Conclusion: According to our preliminary experience with the new two column VA-LCP and its instruments,
the system is easy and convenient to use without significant flaws. The variable angle locking
technology for fragment-specific fixation is reliable providing a stable fixation of different fracture patterns.
The VA-LCP allows early functional postoperative treatment even for complex intra-articular FDR.
57.4
LCP-Osteosynthesis for metatarsal V shaft fractures – a comparison to the non operative treatment
A. Hofmann, D. Topal, J. Forberger, A. Platz (Zürich)
Objective: The metatarsal bones I and V (MT V) are of major functional importance for the diagonal
plantar arch of the foot. Fractures healing in a dislocated position may lead to relevant functional impairment.
In consensus anatomical restoration of these bones is important, favouring osteosynthesis
in dislocated fractures. The literature about functional outcome of these injuries is rare and correct
treatment is still a matter of debate. The objective of this analysis is a comparison of the conservative
in contrast to the surgical treatment.
Methods: A total of 150 patients with MT V fractures were treated from 01/2005 until 12/2008. In
shaft fractures shortening or dislocation of more than 2 mm, as well as axial deviations > 10° or rotational
malpositioning were indications for operative treatment. An almost identical collective of 35
MT V shaft fractures treated conservatively was used for the comparison. Follow-up included clinical
and radiological observation, as well as subjective contentment by using accredited scores. The Foot
Functional Index (FFI) detects pain and functional impairment, the Foot Health Status Questionaire
(FHSQ) includes queries regarding foot pain, function and foot wear domain. The scale ranges from
0 (good) to 100 (poor).
Results: 25 patients (13 women, 12 men) with a median age of 41 (18-77) were treated by using the
2.0 LCP-system and entered the study. No local postoperative complications or implant related problems
were documented. In clinical and radiological follow-up all fractures have healed primarily, but
6 (27%) patients showed hyposensibility in the scar area. Removal of the hardware due to disturbance
was necessary in 8 (44%) one year after primary treatment.
In the group of 35 (19 women, 16 men) conservatively treated patients (median age 47, (11-87)) all
fractures healed primarily as well. No cast induced complications were noted. However the clinical
scores showed lower results favouring osteosynthesis (FFI 5 vs. 15, FHSQ 11 vs. 17).
Conclusion: The conservative as well as the surgical treatment of shaft fractures of MT V entail primary
fracture healing. In our collective the subjective satisfaction of the surgically treated patients showed
better scores than the conservative group. Taking into consideration the indication criteria we state that
plate-osteosynthesis should be recommended in these fractures.
57.5
Gallstone ileus 20 years after cholecystectomy and 6 years after laparoscopic gastric bypass
M. Worni, A. Oesch, W. Keller, S. Voney, U. Laffer (Biel)
Objective: Gallstone ileus is a rare complication of cholelithiasis and accounts for 1-4% of all mechanical
intestinal obstructions. Gallstones migrate through a biliary-enteric fistula and become impacted
at narrow sites like the terminal ileum.
Methods and Results: Presentation of the case
A 69 year old woman was admitted with right lower abdominal pain, nausea, vomiting and diarrhoea.
Physical examination revealed normal borborygmi and palpation was painful in the right lower
abdomen. Past surgical history included gastric bypass procedure for morbid obesity six and cholecystectomy
twenty years ago. Biochemistry showed elevated aP and yGT with 319 U/l, and 381 U/l
respectively, normal bilirubin and transaminases. White blood count was 12.3 G/l, CRP was normal.
Plane abdominal X-ray showed a huge gastric bubble and some small bowel air fluid levels. Gastrographin
follow through and oesophago-gastro-jejunoscopy were normal without signs of leakage in
the gastric pouch. Abdominal ultrasound did not show dilation of intra- and extrahepatic bile ducts.
A contrast-enhanced CT scan showed an ileus with obstruction near the entero-enteric anastomosis.
The cause of the obstruction was unclear. At laparotomy an intraluminal mass near the entero-enteric
anastomosis was palpated and resected. Histology showed a gallstone as the origin of the mass. The
patient recovered well.
Conclusion: Jejunal obstruction due to biliary stones is rare, only 9% of all gallstone ileus occur at the
distal jejunum. The mechanism of the stone formation in our patient remains unclear: either a residual
stone or a recurrent stone have caused obstruction. The former possibility is unlikely because of the
long period of time since cholecystectomy, whereas for the latter several risk factors leading to the
new formation of gallstones are present: advanced age, female gender, obesity, (diabetes?), weight
loss and possibly bariatric surgery. New formation of gallstones occurs in 30-50% 5 years after cholecystectomy.
Small common bile duct stones may not cause bile duct dilatation, however they may increase
in diameter while passing down the bowel due to sedimentation and finally lead to obstruction.
32 swiss knife 2009; special edition
Gallstones have to be considered as the cause of ileus even after cholecystectomy as illustrated by our
case. Computed tomography helps for early diagnosis. Surgery is the treatment of choice.
57.6
Live video transmission of surgery complements the teaching aids in surgical education
U. Genewein, A. Prengel, C. Depner, M. Heberer (Basel)
Objective: High-quality live video transmission of surgery (LVTS)has recently become technically
feasible. Related costs and ethical concerns demand the verification of added values of this novel form
of live interactive teaching in surgery.We assessed the expenditure and value of a three-hour session
of live transmission in gastrointestinal, vascular and orthopaedic-trauma surgery during the Swiss National
Surgical Congress.
Methods: Ethical guidelines were implemented following approval by the respective committee. HD
LVTS via satellite was performed based on a story board pertaining to visceral, vascular and trauma
procedures performed in 3 theaters simultaneously and supported by pre-registered video sequences.
LVTS was evaluated by the participants based on questionnaires filled upon leaving the conference
room. Direct and indirect costs were evaluated based on bills and protocols.
Results: 414 of 1206 (34%) congress participants attended the live transmission. 43%identified themselves
as surgeons in training (SIT), 51% as board certified surgeons (BCS) and 6% as members of
other professions. 82% participants answered the questionnaire. Overall impression was rated as
excellent and good (SIT 99%, BCS 92%). 90% rated the integration of different surgical procedures
appropriate and 73% rated LVTS to be an „important medium complementing presentations, posters
and video sessions“. Only 3% felt LVTS to be an „unnecessary additional session” or „ethically not
acceptable”. Direct costs of LVTS were CHF 70000. Indirect costs (including preparatory meetings,
auditorium rent, surgical specialists guiding and organisational needs) were estimated to CHF 30000.
Therefore total expenditure was CHF 100000, resulting in CHF 240 per participant or CHF 80 per participant
and hour of teaching.
Conclusion: Interaction among different surgical specialists appears to be a value of the multi-speciality
live transmission. Although over all costs appear high, the calculated issues per participant show
that LVTS is a payable educational tool. Current literature of medical education points out unique characteristics
of LVTS as emotional reinforcement of learning, interaction, constructive participation and
problem based learning. LVTS complements current surgical teaching aids due to its unique characteristics
and will gain importance with decreasing costs.
57.7
Periprothetische Femurfrakturen: Analyse von 39 Fällen in der Zeitspanne von 2000 bis 2008
P. Saudan, T. Hotz, K. Käch (Winterthur)
Objective: Die periprothetischen / periimplantären Femurfrakturen nehmen mit dem stetig steigenden
Durchschnittsalter der Bevölkerung zu. Ziel der Studie war es, unsere Ergebnisse im Hinblick auf Frakturheilung,
Non Union und Reoperationen zu analysieren.
Methods: Aus unserem Patientengut mit subtrochanteren bis distalen Femurfrakturen (n = 353) wurden
von uns in der Zeitspanne von 2000 – 2008 insgesamt 39 Patienten mit einer periprothetischen
/ perimplantären Femurfraktur behandelt. Überwiegend handelte es sich dabei um Frakturen vom distalen
Johansson Typ III (n = 37), da die unmittelbar periprothetischen Frakturen vom Typ I und II meist
von den Orthopäden behandelt werden. Die Frakturen wurden mit verschiedenen Plattensystemen (n =
37) grösstenteils winkelstabil (n = 33) versorgt. Bei 2 Patienten wurden nur Cerclagen angelegt. Es erfolgten
regelmässige radiologische und klinische Kontrollen mit wenn möglich einer Jahreskontrolle.
Results: Bei der grossen Mehrheit der Patienten, welche nachkontrolliert werden konnten, kam es im
Verlauf zu einer Frakturheilung. Insgesamt diagnostizierten wir 2 partielle Pseudoarthrosen bisher
ohne Reoperation. Wegen eines Plattenbruches und wegen einer Sinterung eines Prothesenschaftes
musste 2 Mal reoperiert werden. Angesichts des häufig hohen Alters der Patienten mit erhöhter ASA
Klasse verstarben perioperativ 4 Patienten (2 – 10 d postoperativ).
Conclusion: Mit den winkelstabilen Implantaten (vor allem LCP distales Femur 4,5) stehen uns Erfolg
versprechende Implantate zur Versorgung dieser komplexen Frakturen im hohen Alter zur Verfügung.
57.8
Risk factors in alpine skiing - a prospective controlled multicenter survey in 782 patients
R. Hasler 1 , S. Dubler 1 , S. Berov 2 , D. Heim 3 , J. Spycher 2 , H. Zimmermann 1 , A. Exadaktylos 1 ( 1 Bern,
2 Interlaken, 3 Frutigen)
Objective: According to Swiss consumer and insurance studies, about 2.1 Mio. skiers lead to 1000 injuries
per skiing day on average, in Switzerland. New ski material and carving techniques allow skiers
to progress to higher speeds and this might contribute to the high number of injuries. Up to now there
is only little back ground information on risk factors and prehospital care. We therefore conducted a
prospective controlled multicenter survey (Inselspital Bern, Spital Interlaken, Spital Frutigen) to analyze
risk factors leading to accidents in alpine skiing.
Methods: All injured skiers admitted to our tertiary and two secondary trauma centers from November
2007 through April 2008 were analyzed by filling out a validated questionnaire incorporating 13 parameters:
personal data, consumption of alcohol and drugs, skiing experience, experience of aggressive
behavior on slopes, warm-up, snow, weather and slope conditions, information on skiing material,
protectors worn and assessment of risky riding and speeding. The same questionnaire was distributed
to non-injured controls at the end of a skiing day. To detect the influence of the parameters on the dichotomous
variable status (patient, control), multiple logistic regression was performed.
Results: A total of 782 patients and 496 controls were included and analyzed. The following parameters
reached statistical significance and are characteristic for the patients group: high readiness for
risk (p=0.0365, odds ratio 0.69), low readiness for speed (p=0.0008, odds ratio 0.29), no aggressive