Der Unfallchirurg
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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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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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Subtrochanteric femoral fractures are proximal femoral fractures which are located between the trochanter minor and an area of 3 cm below the minor trochanter on the femoral shaft. About 10-15% of all proximal femoral fractures correspond to this fracture site. Elderly or geriatric patients are generally affected and the injury is often the result of a fall in the home, while high-energy trauma is the cause in a small group of generally younger patients. ⋯ The main goals of surgical intervention are to achieve anatomic fracture reduction and primary full weight-bearing stability of the corresponding leg. Intramedullary interlocking nails are used for primary treatment, while extramedullary implants are often used in revision surgery. Early mobilization and intensive respiratory exercises are necessary to prevent early postoperative complications.
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In recent years a trend has evolved from unidirectional to multidirectional locking plates. Different technical solutions have been developed and the quality of the angle stability of all methods has been described as sufficient. Published trials describing the necessary shearing forces are rarely published. We report two cases with loss of reduction after the use of a variable angle locking implant used in distal radius fractures.
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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.