Der Unfallchirurg
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This paper describes the successful nonoperative treatment of a 31-year-old male patient with thoracic and abdominal gunshot wounds. Once stabilized in the emergency department (ED), he was transferred to our general surgical department. On the first day after his admission, diagnostic peritoneal lavage (DPL) was performed, revealing a small amount of hemorrhagic fluid. ⋯ The patient began to tolerate oral feeding quite soon; he was discharged from the general surgical department in a good state of wellbeing on day 13 after admission. This case report supports the idea that nonoperative treatment with repeated physical examination can be an alternative to laparatomy for abdominal gunshot injuries. Further clinical and experimental trials should be performed to test how safe this alternative is.
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The primary goal of drilling procedures for the treatment of osteonecrotic lesions is revascularisation of the defect area. In the literature good results are reported for this technique in 70% of cases. Precise drilling of the necrosed area as part of a minimally invasive technique does, however, require unequivocal intraoperative identification of the region visually, either by arthroscopy or by fluoroscopy. ⋯ In future, we hope it will prove possible to transfer the image data back into the navigation system after they have been merged. At present this is only possible with CT and MRI images. A comparative clinical trial is needed to find to what extent the success rate is improved over that achieved with conventional techniques.
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Case Reports
[Anterolateral thigh flaps for reconstruction of traumatological and oncological defects].
The anterolateral thigh flap (ALT) has become one of the most preferred options for soft tissue defect reconstruction in Asia with an increasing popularity in Europe. The article presents the authors' experience using the ALT flap for various indications in the upper and lower extremities. ⋯ Our experience indicates that the free ALT flap is a reliable method for soft tissue defect reconstruction. The use of the ALT offers many advantages such as a long and large caliber vascular pedicle, a large skin island as well as minimal donor site morbidity. The surgery can simultaneously performed by two teams with the patient in a supine position.
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Case Reports
[Elastic stable intramedullary nailing as alternative therapy for pediatric Monteggia fractures].
Forearm fractures are some of the most common injuries in childhood. Monteggia fractures and Monteggia equivalents are rare injuries of the proximal forearm, but they are important because of their special biomechanics. ⋯ In our investigation, some clinical cases of pediatric Monteggia fractures were operated upon using the technique of elastic stable intramedullary nailing (ESIN). In correct indications, ESIN could be used as a minimally invasive therapeutic alternative to plate osteosynthesis for treating pediatric Monteggia injuries.
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Intracapsular fractures of the femoral neck are mostly treated using individual cancellous screws or a dynamic hip screw in combination with anti-rotational cancellous screws. The goal of this study was to evaluate the possibility of using proximal femoral nails for the surgical stabilisation of intracapsular fractures of the femoral neck. ⋯ The results of our study have proven that the Targon PF biaxial proximal femoral nail may be used in treating intracapsular fractures of the femoral neck.