Der Unfallchirurg
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Pediatric cervical spine injuries are rare. Knowledge of possible types of injury, physiological development and anomalies is necessary in order to not overlook the injury and to initiate suitable therapy. Description of the clinical assessment, Management of diagnostics and therapy of specific injuries. ⋯ In the presence of neurological deficits, identification of the cause is crucial. Odontoid fractures and injuries to the second cervical vertebra are common in upper cervical spine injuries, compression fractures and facet joint dislocation injuries are common in lower cervical spine injuries. Depending on the location of the injury and on the grade of instability, specific therapy, including conservative treatment (orthosis, halo fixation) and operative treatment (internal fixation, fusion) might be necessary.
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Clinical Trial
[Open reconstruction of radius head fractures with and without accompanying ligament instability : Treatment results.]
The treatment of fractures of the radial head is commonly based on the Mason classification. Fractures of the radial head caused by a dislocation of the elbow are summarized as Mason type IV fractures. The purpose of this study was to investigate the outcome and the influence of additional ligamentous injuries after reconstruction of fractures of the radial head. ⋯ Reconstruction of radial head fractures without ligamentous instability led to significantly superior functional results and lower rates of posttraumatic arthritis and heterotopic ossifications than osteosynthesis of fractures with additional ligamentous injury. In these cases primary endoprosthetic replacement might be considered.
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Pediatric pelvic fractures are rare injuries. Typically they are associated with high-energy trauma, which often leads to life-threatening injuries of other organs. Anatomical differences (e.g., greater elasticity, different stages of maturation, remodeling) account for the different fracture mechanisms, fracture management, and outcome in children. The AO Classification (International Association for Osteosynthesis) is useful and can be used as a basis for the treatment algorithm in pediatric pelvic fractures. ⋯ This article provides a review on pediatric pelvic fractures and shows--based on the AO classification--principles of conservative und operative treatment.
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In this article, the anatomical and morphological features of the acetabulum in infancy and childhood are presented. The pathology and treatment of older children and adolescents is deliberately not covered, because the fracture morphology and treatment of patients aged 13 to 15 years is based on the criteria of adult medicine. Especially in the younger child, the anatomical differences are of particular importance. ⋯ Acetabular fractures are particularly problematic in infancy because even with optimal treatment and perfect reduction growth disturbances can occur. These manifest as so-called secondary dysplasia. During treatment, care should be taken to ensure that a surgical team having experience with the infant and juvenile skeleton is available and that appropriate implants are available.
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The combination of proximal and distal radius and ulna fractures with scapholunate ligament injury is extremely rare and this type of injury may potentially only be possible in osteoporotic bone. In this case report this rare injury is discussed, a possible therapy regime is presented and a typical postoperative complication is shown.