Zeitschrift für Orthopädie und Unfallchirurgie
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Comparative Study
[Unstable pertrochanteric femur fractures. Failure rate, lag screw sliding and outcome with extra- and intramedullary devices (PCCP, DHS and PFN)].
The dynamic hip screw (DHS) often shows a high incidence of therapeutic failure and an impared outcome in the treatment of the unstable pertrochanteric femur fracture (31A2). Therefore often an intramedullary device is recommended. In a retrospective clinical study we examined whether the percutaneous compression plate (PCCP, Gotfried) provides advantages following unstable fractures in comparison to DHS and PFN. ⋯ Using the minimally invasive PCCP technique in unstable pertrochanteric femur fractures provides a promising therapy option especially with regard to surgical time, radiographic screening time and failure rate. Lag screw sliding was low. There was no advantage of the intramedullary device PFN.
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Triple arthrodesis is performed to reconstruct a painless plantigrad foot in cases of fixed and painful hindfoot deformity. Mid-term results of our patients after triple arthrodesis concerning clinical and functional as well as radiological outcome were assessed in this examination. ⋯ Triple arthrodesis using internal fixation followed by sufficient immobilisation is a good and reliable technique for the correction of fixed hindfoot deformities. A very high level of patient satisfaction and a good clinical outcome can be achieved. Plantar pressure distribution can be reconstructed to a satisfactory extent. Due to the relatively high rate of degenerative arthritis in adjacent joints, the decision upon performing a triple arthrodesis should be considered carefully. Clinical and radiological integrity of these joints are required.
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The combination of a distal tibia fracture with an additional upper ankle joint injury is a challenge. Apart from various implants the intraoperative problem is the handling of these two injuries with appropriate reduction and retention. The existing and further developing soft tissue damage has to be taken into consideration. The aim of this study is to evaluate the surgical management of this type of fracture. ⋯ One can divide the distal articular tibial shaft fracture into two groups. In the high energy entity the ankle joint injury happens first, and afterwards the tibial shaft fracture occurs. Therefore, both fracture sites are usually not communicating, which means they are in fact two types of fracture. On the other hand, in the low energy group, both fractures are communicating. Here, the tibial shaft fracture is equal to the inner ankle fracture in a classic bimalleolar fracture. Therefore we have only one fracture site.
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The aim of the study was to determine the incidence of deep vein thrombosis (DVT) after pelvic trauma and surgical stabilisation of pelvic and acetabular fractures under medicamentous prophylaxis. ⋯ Early medicamentous prophylaxis can prevent deep vein thrombosis after pelvic trauma. Delayed applications due to pelvic operations are risk factors. In such cases duplex scanning should be performed routinely and postoperative medicamentous prophylaxis should be increased.