Der Unfallchirurg
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Clinical Trial
[Periprosthetic fractures. Long-term results after plate osteosynthesis stabilization].
Due to the increasing age of patients and the rising number of joint replacements, the incidence of periprosthetic fractures (PPF) is also increasing. The treatment should be selected with knowledge of the prefracture interface status and the type of fracture involved. The aim of this study was to evaluate our treatment of PPF with long-term follow-up. ⋯ Due to the minor frequency of severe complications, plate osteosynthesis of a periprosthetic fracture with a loosened interface is a good therapeutic option for individual patients, particularly for geriatric patients and those without disorders specific to a loosened interface.
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Due to the unique anatomy and pathophysiology involved, a compartment syndrome (CS) of the lower leg and foot is prone to develop sequelae that demand operative reconstruction. Moreover, the two regions are closely related. Although research into various pathophysiological areas is revealing specific complexities, aspects of the foot's compartmental anatomy remain controversial, perhaps because of methodological reasons. This may result in particular practices for diagnosing and treating CS in this region, which are discussed in this article.
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Case Reports Clinical Trial
[Surgical management of talipes equinovarus as sequelae of a compartment and/or postischemic syndrome of the deep flexor compartment of the lower leg].
Cases of posttraumatic pes equinovarus after compartment syndrome have become more frequent in the last 3 decades because limb-saving procedures like compartment splitting, vascular repair, and microvascular free flaps have become well established in trauma surgery, thus reducing early below knee amputations. But if the deep flexor compartment is not split completely or if the muscles are crushed by direct trauma severe necrosis and subsequent muscle contractures result in a very severe clubfoot deformity. Metatarsalgia of fifth, fourth, and third metatarsal head even in well-fitted orthopaedic shoes occurs as well as painful bunions and fatigue fractures of the fifth metatarsal. ⋯ By temporary K-wire transfixation (6 weeks), initial external tibiotarsal transfixation of the foot (10 days), and additional tendon transfer for active foot elevation excellent and good long-term (5 years) results are achievable. The results according to the McKay Score are not significantly different regarding the triple arthrodesis group versus the pure soft tissue release group. Nevertheless, saving joints in the latter group seems to be very important.
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Case Reports
[Rare complication of a dislocated rib fracture. Unusual clinical course following a motorcycle spill].
Dislocated rib fractures as a result of traffic accidents can be associated with various injuries of thoracic and abdominal organs. Especial attention should be paid to rare and difficult to determine lesions of a hollow abdominal viscus, which can, if not diagnosed early enough, lead to septic shock with a considerably diminished probability of survival. The following case is of a 51-year-old man who suffered a blunt chest injury with dislocated rib fracture, which caused a gastric perforation that had not been primarily detected. The diagnostic approach with its challenges for treating physicians and alternatives to the standard procedure in the case of dislocated fractures of lower ribs is analyzed here.
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Clinical Trial
[Reconstructive surgery of sequelae of compartment syndrome of the lower leg and/or foot. Presentation of a new classification].
The sequelae of an undiagnosed insufficiently treated or unpreventable (by crush injury) compartment or postischemic syndrome, most often after lower leg fracture or popliteal artery injury, are caused by necrosis and contracture of the extrinsic foot muscles. Therefore claw toes, pes equinus or other forms, such as a severe pes equino varus related to the compartment involved will decide the kind of foot deformity. In cases of a combined compartment syndrome of the lower leg and foot, not only the extrinsic but also the intrinsic muscles especially the short flexors are involved, leading to extensive claw toeing of the hallux and the lesser toes as well. ⋯ Patients with contract hammer toes after calcaneal fractures were seen most often (n=26). Another large group of 24 patients suffered from the sequelae of a compartment and/or postischemic syndrome of the extrinsic muscles of the superficial and deeper compartment of the flexor tendons, producing a severe pes equino varus. Less common (n=16) were the deformities caused by an isolated compartment syndrome, such as necrosis of the anterior tibialis, long extensor muscles, peroneal muscles or a combined compartment syndrome of the lower leg and foot.