Der Unfallchirurg
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Acute compartment syndrome of the upper and lower limbs is observed following trauma, reperfusion or as an intraoperative complication caused by positioning. The pathophysiology of the disorder has been extensively described and is well known as a loss of perfusion due to rising compartmental pressures. It is a serious and potentially limb- and life-threatening complication. ⋯ Thus, in uncertain cases, pressure measurements are essential. Dermato-fasciotomy is the routine method to decompress the compartmental space. This review article examines the clinical findings, diagnostic techniques, and management options for the patient with musculoskeletal injuries.
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Osteoid osteomas are typically located in the femur and tibia and are mostly easy to diagnose based on patient age, the clinical signs and plain radiographs. In contrast, the diagnosis of osteoid osteomas of the foot is often delayed because of the atypical presentation. We report the case of a 24-year-old patient with persisting pain in the ankle joint over 8 years due to an osteoid osteoma of the talus neck.
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A 43-year-old woman sustained a severe ankle dislocation with distal fibular fracture in a domestic accident. This was initially treated with external fixation for 3 weeks. In addition to distal fibular fracture treatment using a fixed-angle locking plate system, a vacuum-assisted wound closure of the medial und lateral malleolus had to be performed due to a persisting difficult soft tissue situation with swelling and necrosis of the medial malleolus. ⋯ The arbitration board furthermore concluded that with a pre-existing osteoarthritis of the ankle, hardware removal was not indicated. In a critical wound situation implant removal would only be indicated with simultaneous treatment of the osteoarthritis of the ankle. By means of a critical indication assessment the patient should have been advised to leave the plate in place and the complicated course with iatrogenic fracture and severely delayed wound healing could have been avoided.
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Soft tissue lesions in the clavicular region may be the result of trauma, infections or oncological resection and necessitate plastic surgery coverage. A case of an 85-year-old woman is presented with non-union of the mid-portion of the left clavicle with an overlying skin defect and a brachial plexus lesion after radiation therapy for breast cancer. The left arm was functionless so after partial resection of the medial part of the clavicle coverage of the defect was conducted by a proximally pediculated anterior part of the deltoid muscle with a split thickness skin graft.