Der Unfallchirurg
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After a fracture of the distal radius, whether healed in an anatomic position or malunited, many patients complain about problems on the ulnar side of the wrist with pain and decreased range of forearm rotation. In addition many patients are unhappy with the unpleasant appearance of the wrist joint. ⋯ Malunion of the distal radius must be taken into account when discussing treatment options. The purpose of this paper is to describe a treatment algorithm with respect to the clinical symptoms, the pathology as well as the presence or absence of a deformity of the distal radius.
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We report a 30-year-old patient suffering a plantar dislocation fracture after he dropped a heavy weight on his foot. The patient was treated immediately after diagnosis was secured by CT scan. Median approach and dermatofasciotomy of the foot were followed by anatomic reduction of the fractures and the Lisfranc dislocation and fixed by internal osteosynthesis. ⋯ Plantar dislocation is a very rare direction of comminuted Lisfranc dislocation fractures. The outcome may be favorable with early reduction and stable internal fixation of the fractures. One always has to be aware of the major soft tissue trauma associated with complex Lisfranc dislocation fractures.
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The formation of a scaphoid pseudarthrosis with avascular necrosis in the area of the carpus is a The formation of a scaphoid pseudarthrosis with avascular necrosis in the area of the carpus is a dreaded complication after conservative or operative treatment of a scaphoid bone fracture, which previously often led to partial or total stiffening operations on the wrist. Vascularized bone grafts can be used to increase the bone fusion rates in the presence of scaphoid pseudarthrosis with avascular necrosis. ⋯ We transplanted a free vascularized cartilage-bone graft from the medial femoral condyle, which was adapted in form and size to the proximal scaphoid bone pole with corresponding cartilage cover and was connected to the radial vascular bundle. This novel operation technique is described in this report and appears to be a promising way of avoiding premature radiocarpal arthritis when treating scaphoid bone pseudo-arthrosis with avascular necrosis in the presence of cartilage destruction.
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Modern communication and information technologies are ubiquitous nowadays, and the medical field is no exception. Telemedicine is a reasonable way to prevent accidents, communicate faster in an emergency, and improve medical care in the hospital. ⋯ This article highlights these subjects and discusses national and international structures that promote the spread of health telematics. Barriers to this path are also shown.