Der Unfallchirurg
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Review
[Management of pre-existing anticoagulation for timely treatment of proximal femoral fractures].
Proximal femoral fractures are urgent indications for surgery. In cases of delayed surgical treatment more than 48 h after hospital admittance, increased rates of general complications, local complications and mortality have been proven. Since 2015, the quality target for the external quality assurance by order of the Federal Joint Committee (G-BA) is surgical treatment within 24 h after hospital admittance for osteosynthesis and within 48 h for joint replacement. ⋯ For 15% of each group of patients a prolonged preoperative preparation is accepted. In the structured dialog within the external quality management anticoagulants are quoted as the most frequent reason for delayed surgery. The present review provides a way to achieve compliance with statutory provisions, to minimize the risks of both bleeding and thromboembolism and to achieve surgical treatment of proximal femoral fractures within the agreed time limit.
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Dislocations of the elbow during growth are rare but because of associated fractures a range of therapeutic methods are employed. The postoperative care is even more varied, so the scientific working group of the section for pediatric trauma of the DGU developed the following recommendations for the treatment of elbow dislocations in children and adolescents based on own experience and a review of the literature. Diagnosis is made from radiographs with at least one (preferably lateral) view showing the dislocation. ⋯ Mobilization is initially limited to the activities of daily life at first. 6 weeks after reduction physiotherapy may be initiated as warranted and patients can participate in sports again. An MRI of the elbow may be necessary if there are persistent problems. Even if a measurable loss of range of motion is often recorded, prognosis regarding a good functional outcome is favorable.
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Evidence-based literature on counseling and treatment of pediatric and adolescent patients with posttraumatic deformities is scarce; however, especially around the elbow with its low remodeling potential, the number of patients with malunions presenting in outpatient clinics is not rare at all. In this review the more frequent indications for corrective surgery around the pediatric elbow are described and treatment proposals are made from the perspective of an interregional reference center for pediatric and adolescent trauma.
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Luxation of the elbow occurs around the age of 7 years instead of a supracondylar humeral fracture. The most common complication is a fracture of the medial epicondyle of the ulna in the sense of a bony avulsion of the ligament. There are only few case reports regarding collateral injuries of the brachial artery. All authors have described this complication as being very rare. ⋯ The clinical suspicion of an injury of the brachial artery justifies a rapid diagnostic investigation by CT angiography and an open vascular intervention as the only possibility to recreate a sufficient blood flow.
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Case Reports
[Isolated fracture of the lesser trochanter-What age-related differences are important?]
Isolated fractures of the lesser trochanter are very rare injuries. This case report describes the age-related differences based on two cases. A 13-year-old girl suffered an avulsion fracture of the lesser trochanter while sprinting. ⋯ After 3 months she could return to the preinjury functional level without impairments. A 55-year-old woman also suffered an isolated fracture of the lesser trochanter, which was a pathological fracture due to a breast cancer metastasis. The cause of an isolated fracture of the lesser trochanter in adults is assumed to be the sign of an underlying malignant disease, until this has been disproven.