Der Unfallchirurg
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The number of patients with osteoarthritis of the ankle, which are treated by arthroplasty, has continuously increased in recent years. The survival time of these implants is far below the results following hip and knee arthroplasty. In some cases a failure rate of approximately 1% per year or a survival rate of 70% after 10 years has been reported. ⋯ In recent years, there has been an increasing trend towards re-implantation of an ankle prosthesis, as this preserves the functionality and mobility of the ankle joint as far as possible. Depending on the reason for failure and the size of the bony defect, a decision must be made regarding a one-stage and a two-stage procedure with bone augmentation. This article presents the advantages and disadvantages of arthrodesis and revision arthroplasty after failed primary ankle arthroplasty and highlights the special features of surgery.
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The aim of supramalleolar conversion osteotomy is to reduce the pain of the patient and stop or at least slow down joint degeneration. The indication for supramalleolar osteotomy is asymmetric osteoarthritis of the ankle joint with varus or valgus deformity. Good clinical results for arthritis can be achieved in the early or middle stages. ⋯ Further studies are necessary to support this. The indications for additional procedures, such as fibular osteotomy are still being discussed. Inframalleolar osteotomy and soft tissue interventions are frequently necessary for balancing the foot.
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Critically injured patients pose great challenges for medical personnel in emergency room treatment. How can such a high workload due to a lack of personnel be reduced? Telemedicine can offer solutions here. ⋯ This possibility should now also be introduced into the care of critical trauma surgery patients. In this article, current emergency room treatment is reflected, problems are shown and future-oriented solutions are suggested.
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Medical education has always been challenging for students and teachers. Of growing importance is the promotion of knowledge of correlations and knowledge transfer from theoretical aspects into clinical practice. In order to achieve this aim, student-centered teaching concepts are increasingly being employed in the literature. ⋯ A case-based teaching concept can significantly improve the education in trauma surgery, when correctly and specifically implemented.
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Explosions can cause severe injuries, which affect multiple organ systems and leave extensive soft tissue defects. In unstable patients, damage control surgery initially focuses exclusively on controlling bleeding and contamination with the aim of preserving life and limbs. ⋯ As the tissue damage caused by the pressure surge can regenerate over time as well as become secondarily necrotic (developing wounds), several revision operations are often necessary to assess the viability of tissue in the sense of serial debridement. In the case of extensive soft tissue injuries temporary vacuum-assisted closure (VAC) techniques can bridge the time to the earliest possible definitive plastic surgical wound closure; however, this must not delay the closure of the defect.