Zeitschrift für Orthopädie und Unfallchirurgie
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Amputation injuries in children occur in motor vehicle, farming and, importantly, lawn mower accidents. Treatment of lawn mower related injuries is complicated by gross wound contamination, avascular tissue, soft tissue defects and exposed bone. Many treatment options exist and often an adequate prosthetic supply is needed for rehabilitation. We report on an 8-year old boy who got under a ride-on lawn mower and sustained a subtotal amputation of his right foot. After initial surgery an amputation was subsequently necessary. For this, it had to be taken into account that the traumatic loss of the talus, calcaneus and parts of the cuboid bone would result in a length shortening of the right leg and so far not injured metatarsal and tarsal bones had to be sacrificed. Thus, we aimed to develop a new operation technique to optimize stump length as well as preserve tarsal bones and the possibility of limb growth. ⋯ Using our stump forming technique we hope to prevent some complications of amputation injuries. Because of the intact epiphysis a bone overgrowth is hopefully prevented and growth potential is preserved and by inclusion of tarsal and metatarsal bones in the stump formation a length discrepancy is minimized.
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Clinical Trial
[Dynamic gait analysis of blocked distal tibiofibular joint following syndesmotic complex lesions].
Dynamic gait analysis of blocked distal tibiofibular joint (TFJ) has not performed yet. This prospective study investigated patients treated for ankle fractures with combined syndesmotic complex lesions after surgery including tibiofibular positioning screw using CT data detecting fibular maltorsion and dynamic gait analysis. ⋯ The temporary blockage of the TFJ results into an altered pattern of dynamic plantar pressure distribution. A constant foot progression angle in relative internal rotation is registered. After removal of the positioning screw the recovered ligamentous structures allow retraction to the anatomic position. But, concerning fibular torsional differences > 15 degrees osseous fixation leads to alterated fpa presented as diminished external rotation of the foot of the formerly fractured ankle with consecutive dysfunction of the physiologic kinematic of movement and eventual provocation of posttraumatic arthritis.
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Injuries of the atlas are always a challenge in diagnostics and therapy. Different clinical manifestations, inconspicuous neurological results, uncertain findings of radiological diagnostics and possible accompanying injuries require individual therapeutic concepts. ⋯ The therapy for atlas fractures orientates on the type of the C1 fracture, the accompanying injuries and the general condition of the patient. Isolated stable C1 fractures without dislocation can be treated conservatively (cervical collar), unstable fractures, depending on the general condition, should be referred to surgical therapy or halo extension. In combined atlas fractures the strategy of treatment has to take the stability of the C1 fractures into consideration, but also the additional injuries of the rest of the cervical spine and the attendant circumstances.