Der Unfallchirurg
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Materials with different characteristics are used for cement augmentation and as bone graft substitutes. ⋯ Cement augmentation has large potential especially in osteoporotic bone. In load-bearing regions acrylic-based cements remain the standard of choice. Ceramic cements are preferred in non-load-bearing areas. Their combination with resorbable metals offers still largely unexplored potential. Virtual biomechanics can help improve the targeted application of cement augmentation.
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[Femoral neck blade cut-in after internal fixation of a trochanteric femoral fracture with a TFNA©].
Following fixation of a trochanteric femoral fracture with a TFNA© and despite correct fracture reduction and fixation, a 96-year-old patient suffered a complete cut-in, i.e. a medialization of the entire femoral neck blade through the nail into the hip joint. Against the background of implant development and current literature, this increasingly frequent type of complication is described and distinguished from other fixation failures such as the cut-out. Attempts to explain this phenomenon as well as research options are presented and a pragmatic approach to avoid this problem is outlined.
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We describe the case of a forest worker with a Gustilo-Anderson III dislocation fracture of the ankle joint. After initial external fixation, round necrotic skin lesions with hyperemic border walls appeared on the entire lower leg. ⋯ Posttraumatic pyoderma gangrenosum is a rare diagnosis. Nevertheless, it needs to be on the list of differential diagnoses if uncommon soft tissue reactions appear.
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Proximal humeral and trochanteric femoral fractures in older patients are typically caused by low-energy trauma and are therefore often associated with osteoporosis. The treatment of such fragility fractures can be difficult as implant purchase is reduced in osteoporotic bone. By augmenting the fixation with cement the contact surface between implant and bone can be increased, which improves the stability of the osteosynthesis. ⋯ Augmentation seems to be a safe and valuable addition to available treatment options especially for patients with fragility fractures.
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Meniscal injuries lead to changes in pressure distribution in the knee joint. The risk of developing gonarthrosis increases by the amount of resected meniscal tissue. Based on 4 MRI examinations conducted over an 8‑year time period, the present case report shows the progress of cartilage degeneration after a traumatic medial meniscus lesion and subsequent partial meniscus resection in a 46-year-old male patient. Congenital or accident-independent risk factors, such as a varus limb deformity must be considered during a medical report.