Der Orthopäde
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The different types of radial head fractures require specific and varying methods of treatment. Between 1982 and 1985, follow-up evaluation of 92 out of 110 patients treated for such fractures at our facility could be performed. The most frequently seen fractures: nondisplaced marginal and marginal sector fractures, as well as fractures of the radial neck, for example, can be treated conservatively. ⋯ Comminuted fractures and neck fractures with an extensive comminuted region as well as displacement of the radial neck more than 20 degrees, require resection, if active elbow movement is not to be expected within 3 weeks. If resection of the radial head cannot be avoided, it should be performed within the first 5 weeks post-injury. Results following early resection are markedly better than those achieved with late resection.
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Compared to other painful conditions on the shoulder suprascapular nerve entrapment is an obscure and uncommon syndrome causing severe shoulder pain and disability, and is easily cured if only it is recognized. The condition was described by Thompson and Kopell in 1959, Schilf reported a case of isolated suprascapular entrapment in 1952. The nerve passes through the suprascapular notch, the roof of the notch is formed by the transverse scapular ligament. ⋯ Electromyographically a decrease in the amplitude or marked polyphasicity of evoked potentials is significant as well as an increased latency time, indicating an impaired conductibility. A surgical release is indicated in case of constant pain and pathological changes of EMG-patterns. From a postero-superior approach decompression of the nerve is performed by simple removal of the transverse scapular ligament.
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In patients suffering from chronic, therapy-resistant shoulder and arm pains, the thoracic outlet compression syndrome (TOS) should be included in the differential diagnosis. It is very important to look out for neurogenic disorders as well as early signs of vascular compression in order to prevent ischaemic injuries. Although the initial complaints appear slight and can in some cases be treated successfully by conservative methods, neurogenic disorders due to TOS as well as arterial and venous manifestations of the syndrome should be treated by resection of the first rib. Only in this way can irreversible neurogenic lesions and arterial or venous complications be prevented.
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On the one hand, out of 115 patients admitted to hospital with 162 various fractures of the cervical spine without injury to the spinal cord, only 3 (2.6%) had an associated lesion to the brachial plexus or nerves in the vicinity. On the other hand, among 500 consecutive patients with injuries to the brachial plexus, 55 (11%) presented fractures of the cervical spine (including T1 and the 1st rib), whiplash injuries, severe distortions and dislocations, and contusions of that vertebral segment. ⋯ Fractures around the shoulder-girdle as well as arterial ruptures are also significant for this severe nerve injury. Of these patients 39 (71%), were victims of motorcycle accidents.
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The foot is a complex structure with numerous articular surfaces. As there are many potential complications (severe edema, compartment syndrome of the intrinsic foot musculature, bone and soft tissue necrosis, joint abnormalities, limitation of movement, deformities, etc.), traumatic surgeons must have a detailed knowledge of the relevant functional anatomy and treatment procedures. If there are multiple injuries, in the context of management, early definitive treatment for the injury is to be stressed. ⋯ In a stable injury, immobilization can be achieved with a cast; in open wounds and malalignment of joint surfaces, an operative procedure is indicated. Particular attention must be paid to injuries of the tarsal bones in children to avoid delayed failure of growth, as the results of radiological investigations are often difficult to interpret. The diagnosis, techniques of management, and principles of follow-up are presented.