Der Unfallchirurg
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As Lisfranc joint injuries are rare and standard radiographic examinations can be difficult to interpret the correct diagnosis is often initially overlooked. Delayed treatment frequently results in painful and disabling arthritis, consequently, primary targeted diagnostics are essential for the functional outcome. We report on a patient with a Lisfranc fracture dislocation, with the injury severity only becoming obvious by dynamic examination with the patient under anesthesia. Due to the massive swelling we performed a minimally invasive primary stabilization using one K-wire and a mini-TightRope®.
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Injuries of the triangular fibrocartilage complex (TFCC) may be fatal to the distal radioulnar joint (DRUJ). This structure is one of the crucial stabilizers and guarantees unrestricted pronosupination of the forearm. A systematic examination is mandatory to diagnose DRUJ instability reliably. ⋯ Osseous ligament avulsions are mostly treated osteosynthetically. Ligament tears may be refixated using anchor or transosseous sutures. Tendon transplants are necessary for an anatomical reconstruction in cases of irreparable ruptures.
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In the initial treatment of severely injured patients a good cooperation of the emergency medical service (EMS) with the hospital team is mandatory. The aim of this investigation was to evaluate the quality of cooperation between hospitals working within a trauma network and the rescue service and to develop a tool allowing assessment of the preclinical and clinical interface. ⋯ This survey presents an adequate tool to identify weak spots within the primary management and to point out elements for improvement.