Der Unfallchirurg
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The following case report shows a young male patient with a complex pelvic trauma due to a traffic accident. In addition to the pelvic ring fracture, he also suffered a severe accompanying injury to the efferent urinary tract in combination with extensive damage of the lumbosacral plexus. ⋯ Due to an infection a wound healing disorder subsequently occurred, which necessitated a myocutaneous flap plasty. This case highlights the complexity of this injury and confirms the necessity for an interdisciplinary individualized treatment.
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Atypical femoral fractures are a very rare complication after treatment with bisphosphonates. This case report describes the diagnostic criteria and some particularities of the surgical treatment. ⋯ Basically, these fractures can be treated using conventional intramedullary nails, which, however, must be used by being adapted depending on the morphology of the femur. The fact that atypical femoral fractures can occur under bisphosphonate treatment should in no way influence the indications for starting anti-osteoporotic treatment.
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Review
[Functional rehabilitation after transfemoral amputation : Shaft prosthesis or endo-exo prosthesis?]
After transfemoral amputation a prosthesis is required to restore autonomous standing and bipedal locomotion. Attachment of the prosthesis can be achieved either classically via socket suspension with a shaft in the stump or directly via implantation of an intramedullary transcutaneous femoral prosthesis (osseointegrated prosthesis). ⋯ In both cases the gait analysis confirmed the advantages associated with an EEP for the transmission of force to the prosthesis and the accompanying improvement in gait symmetry.
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Limited hand function as the result of occupational exposure or accidental injury could primarily be of vascular origin. Since it is quite rarely seen in the course of routine traumatology, special awareness of this is needed. ⋯ Vascular entities can also play a role in the surgical assessment of the impact of an accident or of an occupational disease after exposure to vibration. Awareness of them can shorten the latency between the onset of symptoms and a definitive diagnosis.
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In association with major amputations of the upper and lower extremities, surgical procedures with nerve transfer are increasingly being introduced. In order to examine the value of these procedures the currently available data were analyzed and related to the corresponding insights from conventional amputation surgery as well as confirmed aspects of microsurgery of peripheral nerves. Mainly retrospective observations of low case numbers and sometimes individually different surgical approaches can be found. ⋯ The published results on operative procedures with selected nerve transfers after or during amputation do not currently allow any conclusions about the advantages. Systematic influences in the assessment of the results are probable. Implementation of these treatment options outside controlled clinical trials cannot be recommended.