Der Unfallchirurg
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We report about an 81-year-old male patient who suffered a medial femoral neck fracture after a fall on the left leg. A total hip arthroplasty was planned based on the appropriate indications. The planning was complicated by the presence of an intramedullary Küntscher femoral nail inserted after a motorcycle incident approximately 60 years ago. After fenestration of the proximal lateral femur, the nail was sawn off and a cemented total hip arthroplasty and plate osteosynthesis were performed.
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Multicenter Study Comparative Study
[Thoracolumbar spinal fractures in the elderly : Classification and treatment].
Thoracolumbar fractures in the elderly are frequently associated with osteoporosis. Osteoporosis can cause fractures or be a significant comorbidity in traumatic fractures. The OF classification is based on conventional X‑ray, computed tomography (CT) scan and magnetic resonance imaging (MRI). ⋯ The score takes the current clinical situation including patient-specific comorbidities into consideration. The treatment recommendations are based on an expert consensus opinion and include conservative and operative options. If surgery is indicated, vertebral body augmentation, percutaneous stabilization and even open surgery can be used.
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Three-dimensional (3D) imaging can enhance trauma care by allowing better evaluation of bony detail and implant position compared to conventional fluoroscopy or x‑ray. Intraoperative 3D imaging further improves this evaluation by allowing any necessary revisions to be made in the operating room prior to the patient emerging from anesthesia. ⋯ Improved image volume, resolution, and software capability have allowed surgeons to obtain high-quality, wide field views of bony anatomy that can include the uninjured side as a comparison. In this paper, the evolution of intraoperative 3D imaging over the past 25 years is discussed.
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Injuries of the peroneal tendons are rare and often overlooked. Typical pathologies are tendinitis, tears and dislocation. Accompanying injuries are fractures. They are often associated with instability in the ankle and rearfoot deformities; therefore, these pathologies should be excluded or taken into consideration in the treatment. The clinical examination is crucial for the diagnosis. ⋯ Rehabilitation after operative treatment is demanding and prolonged especially after operative therapy of peroneal tendon tears. The results to be expected appear promising.
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The most favorable treatment for acute Achilles tendon ruptures remains controversial. In particular, three key questions are intensively debated: is operative or non-operative treatment superior? If surgery is performed, should open or minimally invasive percutaneous techniques be used? How should the follow-up treatment be carried out? The aim of this article is to answer these essential questions based on the currently available evidence. Non-operative treatment leads to a higher rate of re-ruptures and inferior functional results when compared to operative treatment. ⋯ Nevertheless, treatment protocols vary greatly with the majority still carrying out open suture and immobilizing follow-up treatment with fixed plantar flexion. Based on the available data the authors recommend minimally invasive percutaneous suture of the tendon followed by progressive functional rehabilitation. Implementation of the available evidence into routine practice is the next important step for successful treatment of this challenging injury.