Der Unfallchirurg
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This case report describes the successful fixation of a periprosthetic patellar fracture in an 89-year-old female patient after total knee arthroplasty (TKA) and cemented retropatellar component. Fixation was performed by use of a fixed-angle plate combined with cerclage, under preservation of the firmly fixed retropatellar prosthetic component. No complications were observed postoperatively. ⋯ The patient was free of pain and had an age-appropriate mobility. The use of fixed-angle plates in the treatment of type II periprosthetic patellar fractures according to Ortiguera and Berry can provide stable fixation while preserving the retropatellar prosthetic component. Additional augmentation by cerclage, tapes or traction screws is recommended in cases of poor bone stock or severe osteoporosis.
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Traumatic nerve injuries are associated with a high morbidity and long rehabilitation times. The extent of a nerve lesion and the related regeneration potential can often only be estimated during the course, whereby the time window for successful surgical interventions is limited. ⋯ A strategic approach to conservative and surgical treatment of traumatic nerve injuries depending on the extent of injury and resulting regeneration potential is recommended. In conjunction with the clinical course, electrophysiology and imaging diagnostics, e.g. nerve sonography, can help to differentiate between neurapraxia, axonotmesis and neurotmesis.
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A reliable reconstruction of soft tissue defects of the lower extremities especially in the distal third of the leg is still a special challenge for reconstructive surgeons. The possibility of salvaging the leg has to be evaluated in the setting of an interdisciplinary team and the timing of the operation(s) with respect to the safety of the patient and a systematic approach with the selection of a suitable flap have to be defined. ⋯ Recently perforator-based flaps have gained popularity for reconstruction of lower extremity defects. Furthermore, new surgical techniques and developments in association with the demographic change have led to a paradigm shift.
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Soft tissue defects of the foot are very common sequelae after trauma and require an individual reconstructive approach. ⋯ Precise preoperative reconstructive planning and analysis of the vascularization form the foundation for a successful soft tissue reconstruction of the foot. The aims of the individualized approach to soft tissue reconstruction of the foot are stable soft tissue coverage, resistance to weight bearing of the sole of the foot, the ability to wear normal shoes and maintenance of sensibility.
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Polytraumatized burn patients represent a rare patient collective and necessitate an individualized treatment concept due to the particular combination of injuries. ⋯ Polytraumatized severely burned patients necessitate an interdisciplinary treatment approach, whereby preservation of length, functionality and esthetic appearance of the affected extremities and concurrent avoidance of bone and soft tissue infections have utmost priority.