Der Unfallchirurg
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Femoral shaft fractures after completion of growth predominantly affect young people with healthy bones. The causes are mostly high-velocity traffic accidents, crushing or running over mechanisms and falls from a great height. Gunshot wounds are relatively rare in Germany but have a certain importance internationally and in military medicine. ⋯ Spiral fractures are a sign of indirect force and are therefore frequently found in older patients with osteoporosis. Atypical fractures under or following bisphosphonate treatment are a new entity, which are typically subtrochanteric and begin on the lateral side of the bone. The characteristics of pathological fractures, femoral shaft fractures in childhood and adolescence as well as periprosthetic fractures are not dealt with in this article.
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While fractures around the knee are known to be rare, physicians have encountered a rise in the frequency due to the increased participation of children and adolescents in high-impact sports at a younger age. Even if the treatment of fractures in some cases resembles that in adults, the diagnostics and treatment in childhood and adolescence require a hígh level of experience in order avoid possible sequelae and to enable early recognition. Thorough diagnostics using clinical and imaging investigations as well as a precise weighing up of the treatment are essential to minimize differences in leg length and axial malpositioning of the leg. ⋯ Decisive is the degree of dislocation of the fracture. In operative treatment, the axis conform reduction and subsequent stress stable treatment are particularly decisive. Avulsion trauma, bony avulsions of the intercondylar eminence and patellar injuries are also treated conservatively with immobilization or surgically with the aid of various fixation techniques, depending on the degree of dislocation.
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Dislocation of the patella is one of the most common knee injuries in childhood and adolescence. After detailed clinical and radiological clarification, conservative functional treatment with special orthotic devices is most commonly applied in patients with a primary dislocation without concomitant injuries; however, the redislocation rate after conservative treatment has been reported in the literature to be between 35% and 70%, depending on the risk factors present. ⋯ Many scientific contributions on the topic notably in the last two decades have increased the understanding of patellofemoral instability. The comprehensive knowledge of the causes for a persisting instability of the patella has made the treatment more efficient and precise but also more complex.
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Fractures in childhood can result in malalignment and/or leg shortening due to insufficient reduction, malunion or injury to the growth plate. ⋯ Precise analysis of the deformity and leg length discrepancy is necessary to select the best point in time and the right surgical procedure and hardware for correction.
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Review
[Anterior cruciate ligament rupture in children with open growth plate : Diagnostics and treatment].
Anterior cruciate ligament (ACL) ruptures in pediatric patients with open growth plate are of concern and the number of injuries is increasing. The possibilities for diagnostics using magnetic resonance imaging (MRI) have improved and are without radiation exposure to the growing skeleton. The MRI should be performed routinely in every case of adequate trauma also to recognize additional injuries to the knee joint. ⋯ Despite the different surgical techniques, the general recommendation is for replacement of the ACL. Extensive procedures with an increased risk of epiphyseal injury should be avoided and anatomical techniques should be preferred. The results are good to very good and with adequate knowledge of the special features of children, complications are rare.