Der Unfallchirurg
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We report the case of a 69-year-old female patient who sustained a traumatic anterior dislocation of the tibialis posterior muscle tendon. A computed tomography (CT) scan demonstrated an osseous avulsion of the flexor retinaculum with the tendon dislocated underneath it. The patient underwent surgical exploration with reduction of the tendon to its anatomical position and screw fixation of the avulsed fragment. The postoperative course showed pain-free mobility and no signs of tibial posterior muscle tendon insufficiency.
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Peripheral nerve injuries are often encountered in traumatological care. The aim of this manuscript is to provide initial data, experiences and performance reports from Germany in the implantation of acellular human nerve transplants in peripheral sensory nerve defects of the hand and to put these data in the context of a comprehensive review of the literature. ⋯ All patients had a clinical improvement after nerve reconstruction (≥ S3 according to the classification of sensory recovery of the Medical Research Council modified by Mackinnon and Dellon). Disadvantages of our clinical study are the small number of patients, the inhomogeneity (primary and secondary nerve reconstruction) and the lack of comparison with other nerve reconstruction methods.
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Nonunions after median sternotomy are rare and usually respond well to surgical treatment. Recalcitrant nonunions despite surgical treatment require a comprehensive mechanical and biological treatment strategy to achieve an adequate functional result for the patient. ⋯ Through a surgical approach guided by the criteria of the nonunion scoring system (NUSS) successful healing was achieved. Our strategy as well as the treatment course are presented.
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In consequence of a car accident a 20-year-old woman with bilateral fractures of the femur and an unilateral lower leg fracture was treated with external fixation. Afterwards she was soporific with signs of impaired consciousness and required intubation and intensive medical care surveillance. ⋯ Subsequently, definitive treatment was performed by intramedullary nailing. After neurological and orthopedic rehabilitation no performance inhibiting limitations remained.
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In this article the basic principles of fracture sonography and meaningful areas of application in children and adults are explained. The sonographic fracture signs are presented and the typical areas of application, i.e. clavicular fracture, acromioclavicular (AC) joint dislocation, proximal humerus fracture, elbow fracture, wrist fracture, metacarpal 5 fracture, palmar plate, femoral bulge fracture, proximal tibia fracture, midfoot V fracture, toddler's fracture and march fracture, are outlined and known diagnostic algorithms are listed. When used correctly, fracture sonography is a safe, gentle and rapid diagnostic method.