Der Unfallchirurg
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Case Reports
[Retrograde tibial intramedullary nailing with the Flex Nail--treatment of tibial fracture in an unusual case].
We report a case by a 75 year old female patient suffering a third-degree open fracture of the shinbone with a severe damage of the soft tissue. Primary operation was a temporary fixation with a fixateur externe and a radical debridement of the soft tissue with vacuum-sealing. Ten days later we did the definitive surgery. ⋯ The defect of the soft tissue was treated by a muscle flap and meshgraft transplantation. Healing of the soft tissue and beginning consolidation of the fracture comes after 4 months. In our opinion the retrograd inserted Flex-Nail is a good option for treatment of compound fractures of the lower leg in special cases.
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40 acute traumatic ruptures of the Achilles tendon were evaluated in a prospective study after open repair using an early functional rehabilitation protocol. The age of the patients averaged 43 (23-64) years. The operation consisted of a Kessler suture and microadaptation of the tendon. ⋯ There were no perioperative complications. One rerupture occurred 6 weeks postoperatively and was operated successfully. The combination of surgical repair and early functional after treatment resulted in normal function after 1 year, but requires cooperation of the patient.
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For ventral instrumentation of spine fractures it is necessary to have an special implant for replacement of spine-body. Therefore we use titanium-cages, bone-cement and cortico-spongious pelvis bone. These are afflicted with a not so small morbidity. ⋯ In the following cases we describe four cases of dislocation of the synex-cage. In one patient an operative revision was indicated. In the other cases the mobilization was to be reduced.
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The most common method of treating the arthrotic distal radioulnar joint (DRUJ) is resection of the entire ulnar head (Darrach procedure). Complications related to instability of the distal forearm resulting from loss of the ulnar head are usually manifested by pain and weak grip strength and have remained the drawbacks of this procedure. In an attempt to mechanically stabilize the distal forearm, an endoprosthesis was developed to replace the ulnar head after Darrach resection. ⋯ The implantation of the ulnar head endoprosthesis effectively restored the stability of the DRUJ. There were significantly better results after the implantation of the prosthesis compared with the Darrach and the soft tissue stabilization procedures. This study provides laboratory validity to the option of implanting an ulnar head endoprosthesis as an attempt to stabilize the distal forearm after Darrach resection in lieu of performing soft tissue stabilization techniques.
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It is wise for surgeons to critically analyze their decision making, to add evidence in addition to the normal approaches, i.e. expert opinion and pathophysiological rationale. What evidence, is how it works, how often it is used in orthopedic surgery are the main topics of this article, as well as problems and limits to evidence-based medicine (EbM). EbM operates in five steps: 1. formulate an answerable question with respect to the patient's problems; 2. search the relevant literature; 3. critically appraise the assembled information through evidence based standards; 4. implement these evidence supported findings in your daily practice; 5. evaluate your evidence-based practice. ⋯ The literature already demonstrates that EbM attains its goal. A valid judgment of EbM will result if one evaluates one's own evidence-based practices. The implementation of EbM is also a matter of policy.