Der Unfallchirurg
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Case Reports
[Treatment strategy for posttraumatic complex deformity : After bilateral femoral shaft fractures].
A case of complex posttraumatic deformity after bilateral femoral shaft fractures is reported. Different possibilities for correction in cases of valgus malalignment combined with internal rotation deformity as well as shortening combined with external rotation deformity are presented. Oblique osteotomy and a motorized femoral extension nail were used.
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Review Comparative Study
[Treatment of lateral ankle joint instability : Open or arthroscopic?]
Chronic ankle joint instability often necessitates operative treatment. Operative treatment methods are classified into non-anatomical tenodesis, anatomical reconstruction and direct repair. In addition to open approaches, arthroscopic techniques are increasingly becoming established. This article describes the various operative treatment procedures, their advantages and disadvantages and in particular the arthroscopic feasibility.
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Tibiotalocalcaneal arthrodesis (TTCA) is indicated for a variety of disorders, including end-stage osteoarthritis, severe deformities and complications after operative interventions on the upper and lower ankle joints. Due to the biomechanical advantages, TTCA is predominantly performed with curved retrograde intramedullary nails allowing compression before locking. Hindfoot arthrodesis is most commonly performed by extensive open surgical approaches. ⋯ Arthroscopic TTCA therefore appears to be a promising alternative approach. Even though only few case reports and one case series have been published, in the total collective of 17 patients only one subtalar non-union and one minor complication were reported. Despite the limited evidence available, arthroscopic TTCA appears to be a promising therapy option in patients with an increased risk profile and comorbidities, such as critical soft tissue situations, plantar ulceration, peripheral arterial occlusive disease (PAOD) and diabetes mellitus.
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Ankle impingement syndromes are one of the most frequent chronic and posttraumatic pathologies of the ankle joint. Anterior and posterior impingement result from the abutting of anatomical structures leading to pain and limitation in the range of motion of the ankle joint. Ankle impingement can be classified based on the localization or the underlying cause. ⋯ From a therapeutic perspective, conservative treatment should be initially attempted. If non-operative treatment fails, arthroscopic resection and debridement of the underlying cause is nowadays the standard method of surgical treatment. With a current complication rate of approximately 3 % ankle arthroscopy is a safe operative method, which is associated with a high postoperative rate of patient satisfaction and significant relief of symptoms.
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Review
[Fractures of the proximal interphalangeal joint : Diagnostic and operative therapy options].
Joint fractures of the fingers often entail operative interventions in contrast to extra-articular fractures. These types of fracture are inclined to dislocate in addition to the actual fracture. The proximal interphalangeal (PIP) joint in particular often shows comminuted fractures due to the long leverage of the finger and a relatively small diameter of the joint. ⋯ A multitude of operative techniques are available for these mostly complicated fractures. The foremost goal is a stable osteosynthesis of the fracture with repositioning of the dislocation, which enables early physiotherapy in order to prevent tendon adhesion and contracture. This article presents the different types of PIP joint fractures, their specific surgical treatment and postoperative treatment regimens.