Der Unfallchirurg
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Between 1988 and 1994, 295 patients with blunt chest trauma were treated. Forty-two patients had flail chest, requiring mechanical ventilation. Open reduction and osteosynthesis (ASIF reconstruction plates or isoelastic rip clamps) of the chest wall were performed in 20 patients. ⋯ No complications related to the osteosynthesis arose during the follow-up. In conclusion, the best indication for early operative chest wall stabilization is flail chest without pulmonary contusion, leading to a significant reduction in the duration of ventilatory support. Secondary stabilization is recommended in patients with pulmonary contusion showing paradoxical movement of the chest wall during weaning from the respirator.
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Pathological or spontaneous fractures in childhood are rare and are mostly caused by benign bone diseases; the fractures must be treated on an individual basis, as there are no constant rules. Since the new method of osteosynthesis called "elastic stable intramedullary nailing" (ESIN) or "embrochage centro-medullaire elastique stable" (ECMES) has demonstrated the best results in the treatment of normal fractures in childhood, this method is rapidly being used in the treatment of spontaneous or pathological fractures. We report our experience in the treatment of spontaneous fractures in childhood with "elastic stable intramedullary nailing", in nine patients with ten fractures. ⋯ The location was the femur (two cases) and humerus (seven cases). All fractures healed completely without pseudarthrosis; as complications we saw one incidence of osteomyelitis, one of a second fracture after "elastic stable intramedullary nailing" and one coxa vara in a child with histiocytosis X of the proximal femur. In the 5 children with juvenile bone cysts the nails are still in situ; in two cases the nails had to be changed.
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Case Reports
[Combined total endoprosthesis implantation in bilateral femoral neck fracture with osteogenesis imperfecta tarda].
Osteogenesis imperfecta tarda is a hereditary disease with an insufficiency of osteoblasts caused by a collagen disorder, insufficient formation of osteoid and an impediment of periosteal bone formation. This leads to increased fragility of the bones and, as a consequence, to the risk of fractures. We report a simultaneous, bilateral medial femoral neck fracture, caused by a cerebral cramp attack. ⋯ We implanted a cemented total endoprosthesis on each side in just one operation. There were no complications in the intra- and postoperative course. A walking aid gradually increased the patient's mobility so that he could be discharged on the 21st postoperative day.