Der Unfallchirurg
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Using anatomic specimens from 58 fixed femurs, we analyzed the point of insertion and junctional variations of the gluteus medius, minimus and vastus lateralis over the greater trochanter. On six specimens the physiological muscle cross-section Q was determined for the muscles inserting at the greater trochanter. The results showed that the gluteus medius and minimus, as well as the vastus lateralis generally insert at the lateral and ventral surfaces of the greater trochanter. ⋯ An operating technique for the implantation of tumor prostheses using this muscle sling is introduced. Hereby the greater trochanter and inserted musculature remain intact and are placed hoodlike on the implanted tumor prosthesis. Postoperatively, the procedure results in good muscle function with early exercise tolerance.
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Intra-articular fractures of the distal end of the humerus are severe injuries because stable anatomic reduction is difficult to achieve even operatively. They are often accompanied by nerve lesions and often lead to heterotopic para-articular ossifications. Functional recovery is only rarely complete. ⋯ In immediate operations we observed fewer infections, less ossification, and better functional results than after delayed operative treatment. We therefore recommend careful examination for nervous deficits, immediate stable internal fixation of the fractures displaying the ulnar nerve, and handling the soft tissue as gently as possible to avoid additional damage. Postoperative physiotherapy should also be started immediately.