Der Unfallchirurg
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The rate of pediatric equestrian injuries is relatively low, but the severity of injuries is greater than in many other pediatric sport activities. In a 4-year period the charts of 109 patients up through the age of 15 years, who were admitted for equestrian-related injuries were reviewed. Falls from horses are the most frequent cause of injuries and responsible for their anatomic localization and type of injury. ⋯ Forty percent of all injuries were fractures, 72% of which were fractures of long bones. The circumstances surrounding the accident and mechanisms of these injuries were analyzed. Effective safety measures such as improved equestrian helmets and adequate training in dealing with horses could reduce the risk of injuries.
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The evaluation of 174 humeral shaft fractures treated operatively in our institution and a literature review are used to illustrate the indications for operative treatment. For some indications, the authors prefer Hackethal's bundle nails. A simple operative technique and a small approach incision far distant from the fracture site, which prevents the fracture hematoma, and the very low complication rate are the advantages of this method, making it an alternative to plating and even to bracing. ⋯ Closed fractures without concomitant injuries can generally be managed conservatively. We have treated 84 of these fractures with Hackethal's nails. The only serious complications were one non-union (1.2%) and one deep infection (1.2%).
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From 1977 through 1992 a total of 25 children (age 4 months to 14 years) were hospitalized for pelvic fractures. Clinical outcome and X-ray evaluation had been recorded and were retrieved for 21 children. ⋯ All pelvic fractures healed uneventfully whether treated by surgery or conservatively. Concomitant injuries, treatment, and types of pelvic fracture are discussed.
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Between 1982 and 1993 we performed internal fixation or resection in 95 adult patients for radial head fracture. It was possible to follow up 68 patients for an average of 2.1 years. In 53 cases the initial injury was an isolated radial head fracture, which was treated by internal fixation in 41 and resection in 12 cases. ⋯ A satisfactory outcome was associated with young age, little initial fragment dislocation, internal fixation with screw + K-wire, and early postoperative physiotherapy. Primary resection for crush fractures of the radial head did not have negative long-term effects. In a comparison group with complex elbow injuries (elbow luxation in 9 and a Monteggia-type injury in 6 cases) in addition, results were considerably poorer and did not depend on the above-mentioned factors.