Der Unfallchirurg
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Between 1980 and 1996 we treated 23 patients for dislocated fractures of the talus. The injury was caused by a car accident in 61% and a high fall in 22%. Five patients had open wounds (22%), two developed compartment syndrome of the foot (9%) at an early stage, and 11 patients had multiple injuries. We used the classifications of Hawkins and Marti/Weber. All fractures were surgically treated by fixation with screw osteosynthesis, percutaneous wire transfixation, and/or external fixation. Fifteen patients with dislocated fractures of the talus underwent clinical and radiological follow-up examinations using the Kiel score. ⋯ Even immediate anatomical reduction and sufficient stabilization cannot always decrease the rate of talar necrosis and peritalar arthrosis.
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From 1996 to 1999, 572 fractures of the clavicle were treated in our department, 26 of which were located at the lateral end of the clavicle. Two children were operated: in one a closed reduction of the fracture under general anesthesia was performed, and in the other the fracture required open reduction with internal fixation. All other fractures were treated conservatively with a figure-of-eight clavicle strap for 3 weeks. ⋯ Sixteen patients came to our outpatient department for clinical and radiological control, and three patients informed us by phone. All patients including the two treated under general anesthesia were fully recovered and had no problems doing their job and engaging in different sports. The radiological controls showed a good ossification without visible deformity of the clavicle.
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Measurement of intracranial pressure (ICP) has to be regarded as a standard procedure in today's treatment of severe head-injured patients. Intraventricular or intraparenchymal measurement should be used. ⋯ Computer-based analysis of the ICP-signal provides further options of an online monitoring of intracranial reserve capacity and the state of autoregulation. However, until now, there are no software solutions commercially available which would allow for such advanced signal analysis--the reason might be that the potential of advanced signal analysis has only been discovered within the recent years.
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The treatment of pilon fractures and distal metaphysial tibia fractures demands very high standards on the osteosynthesis material regarding the soft tissue and the essential joint reconstruction. The selection of the surgical entrance, particularly in case of a critical arterial or venous circulation and the possible irritation of the soft tissue caused by the osteosynthesis material led us to search for alternative osteosynthesis methods. ⋯ Within a time period of 8 month 5 fibula fractures coming with pilon fractures had been treated with the XS-nail. This case report will demonstrate both the technique of treatment and the flexibility of the new implant.