Der Unfallchirurg
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The development of emphysema after intramedullary nailing can represent an easily manageable complication but in the differential diagnostics it could, however, be a life-threatening infection with Clostridium perfringens. This is a report about the case of an extensive subcutaneous and retroperitoneal emphysema, which developed after intramedullary nailing of a pertrochanteric femoral fracture and where such an infection was suspected.
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Intramedullary nailing was originally conceived for the stabilization of shaft fractures of long bones. Due to new nail designs and multiple interlocking possibilities, the spectrum of nailing has significantly increased. Nailing of fractures beyond the isthmus is technically challenging because fractures need to be reduced before the nailing procedure starts. ⋯ Blocking screws create an artificial isthmus in the metaphyseal area and force the guide wire in the desired direction. Blocking screws help to avoid axial malalignment during nail insertion. Interlocking of the nail with screws coming from different directions prevents secondary dislocation.
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Nearly 80 years ago in the autumn of 1939 Gerhard Küntscher successfully stabilized a patient with the first intramedullary nailing surgery. As a result, the research interest in osteosynthesis significantly increased. ⋯ The study showed the eminent impact that the close cooperation between Küntscher and Pohl had on the success of the intramedullary nail. The synergy of Küntscher's medical expertise and Pohl's ingenuity found solutions for problems other people could not solve. World War II interrupted this close interaction but at the same time helped to disseminate the technique globally which in turn contributed to the advancement of the idea.
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The deltoid or medial collateral ligament consisting of superficial and deep components together with the spring ligament is the primary stabilizer of the ankle joint. Injuries of these anatomical structures are more frequent than assumed but are nevertheless often overlooked. Inadequate treatment can lead to chronic pain, instability, hindfoot deformities and ankle arthritis. ⋯ Magnetic resonance imaging (MRI) is the diagnostic method of choice. Arthroscopy of the ankle joint can be a valuable tool in the assessment of the injury. Treatment should include accompanying injuries and deformities and can range from immobilization in a cast to ligament repair up to ligament reconstruction using a free tendon graft.