Der Unfallchirurg
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Randomized Controlled Trial
[Augmentation technique on the proximal humerus].
The treatment of osteoporotic fractures is still a challenge. The advantages of augmentation with respect to primary in vitro stability and the clinical use for the proximal humerus are presented in this article. ⋯ The augmentation of the screws in locked plating in a proximal humerus fracture model is effective in improving the primary stability in a cyclic varus bending test. The targeted augmentation of two particular screws in a region of low bone quality within the humeral head was almost as effective as four screws with twice the amount of bone cement. Screw augmentation combined with a knowledge of the local bone quality could be more effective in enhancing the primary stability of a proximal humerus locking plate because the effect of augmentation can be exploited more effectively limiting it to the degree required. The technique of augmentation is simple and can be applied in open and minimally invasive procedures. When the correct procedure is used, complications (cement leakage into the joint) can be avoided.
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Due to the demographic change fractures of the proximal femur are an increasing major healthcare problem and are associated with the highest mortality among frailty fractures. ⋯ In addition to the optimal surgical treatment, secondary prevention such as osteoporosis management to avoid further fractures is crucial in the treatment of these patients. This article is based on the current literature and provides an overview of the possible applications of cement augmentation for the treatment of proximal femoral fractures. In addition the surgical approach as well as previous scientific data on an established osteosynthesis using cement-augmented PFNA for the treatment of pertrochanteric frailty fractures are presented.
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Multicenter Study
[Treatment of proximal humeral fractures in Germany : Influence of the level of hospital care and the frequency of treatment.]
Various treatment options exist for displaced proximal humeral fractures. The impact of the level of hospital care and frequency of treatment on current treatment regimens in Germany was analyzed. ⋯ Independent of the level of hospital care and frequency of treatment, there is a trend for head-preserving angular-stable surgery with a homogenous level of treatment in Germany.
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Pilon fractures are articular fractures of the distal tibia which involve the weight bearing part of the ankle joint. Assessment of the fracture is carried out with computed tomography and evaluation of the skin and soft tissue damage. ⋯ The surgical approaches are preferably local and when necessary multiple (up to three) and performed simultaneously but the localization also depends on the trauma-induced damage. The surgical strategy includes joint distraction, sequential joint reconstruction and joint axis correction as well as early non-weight bearing joint mobilization.