Zeitschrift für Orthopädie und Unfallchirurgie
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In polytraumatised patients, fracture management depends on the overall injury severity. For decision making, patients are grouped in one of four categories (STABILE, BORDERLINE, INSTABLE and IN EXTREMIS). STABILE patients should and BORDERLINE patients may undergo primary definitive fracture stabilisation; in contrast, this is not recommended for INSTABLE or IN EXTREMIS patients. ⋯ The indication for fasciotomy covers a wide field and may be performed prophylactically. The decision for amputation is based on the patient's general condition and the soft-tissue and neurovascular status. Scoring systems are useful for decision making, however individual decisions should be made.
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Intramedullary nailing is a standard procedure to treat femoral fractures in patients without polytrauma. Nevertheless, non-union in femoral fractures is a common complication with an incidence of 12.5 percent, mostly arising for mechanical reasons. The aim of this study is to find out whether the increase of stability through an augmentive plate fixation (if necessary with bone grafting) with leaving the nail in situ is adequate to treat the non-union successfully. ⋯ If indicated, the herein demonstrated procedure with an augmentive plate fixation while leaving the nail in situ is simple and safe. Although the intramedullary canal is potentially affected through the initial nailing, the healing of femoral non-unions was observed in the majority of cases in spite of the additional extramedullary approach for plating and bone grafting.
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The aim of the present study was the verification of the accuracy of 2-D fluoroscopy-based navigated pedicle screws at the thoracic and lumbar spine in a case series of traumatised patients. Within 36 months 111 pedicle screws in 29 patients were instrumented using C-arm based navigation, 60 at the thoracic and 51 at the lumbar spine. All screw positions were evaluated postoperatively by a routine thin slice CT scan using multiplanar reconstruction. ⋯ Segmentation of the C-arm navigation into two comparable treatment periods showed a learning curve with a reduction of perforations in the second sequence (after 57 pedicle instrumentations) of about 15%, this was found to be not statistically significant. The fluoroscopic navigation of pedicle screws is a safe procedure at the lumbar spine with equal accuracy compared to the non-navigated conventional instrumentation. Application of C-arm navigation at the thoracic spine showed more inaccuracies, so that 3-D-based navigation seems to be advantageous in this region.
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Case Reports Comparative Study
[Minimally invasive T-plating at the proximal humerus].
A generally accepted recommendation for the optimum surgical treatment of unstable, dislocated fractures of the proximal humerus is not yet available. According to the general surgical trend to minimally invasive techniques, the object of this study was to conduct follow-up examinations of the technique of minimally invasive T-plating at the proximal humerus developed at our hospital and to compare the results with those of other osteosynthetic techniques, especially concerning the complications of the surgical approach and the clinical outcome. ⋯ The expectations for this technique were not met. Minimally invasive T-plating could not be shown to be superior to other techniques.