Der Orthopäde
-
The complex injury is characterized by a fracture and/or dislocation of the elbow in association with a serial injury of the upper extremity, or a severe soft tissue trauma, or a prolonged ischemia caused by vascular injury or compartment syndrome. They are defined as complex injuries because their treatment differs from that of a simple fracture implying that standardized concepts usually cannot be employed. The results of primary treatment show a high rate of complications. ⋯ Rehabilitation outcome depends on primary therapy. Sufficient functional results are only achieved after early mobilisation and intensive physiotherapy. If necessary, arthrolysis is planned early and combined with removal of implants at 6 months post injury.
-
Following complex foot injuries (incidence up to 52%) in the multiply-injured patient the ultimate goal remains the same as for all significant foot injuries: the restoration of a painless, stable and plantigrade foot to avoid corrective procedures with moderate results. In the case of a complex trauma of the foot (5 point-score)--e.g. a crush injury--primary amputation in the multiply-injured patient (PTS 3-4) is indicated. Limb salvage (PTS 1-2) depends on the intraoperative aspect during the second look (within 24-48 hours after injury): the debridement has to be radical, the selection of amputation level should be at the most distal point compatible with tissue viability and wound healing. ⋯ Open reduction and internal fixation are achieved either by 1.8 mm K-wires or 3.5 mm cortical screws. To avoid further soft tissue damage a delayed primary closure can be necessary and a temporary tibio-tarsal transfixation is useful. Despite the life-threatening injuries of the multiply-injured patient one must insist on an exact diagnosis of the foot trauma (radiographs in 3 standard projections: exact lateral, dorso-plantar, 45 degrees oblique) if long-term disability due to articular incongruities and complex derangement of the arc geometry of the foot is to be avoided.