Der Unfallchirurg
-
Burns and thermal injuries from other causes often affect exposed body regions such as the hands. Besides aesthetic aspects, deep dermal burns of the skin are often critical from a functional point of view, especially for important subcutaneous structures. This article reports the course of two patients who received enzymatic debridement with bromelain-based salve as a treatment for deep grade burns of the hands.
-
Metatarsal and toe fractures are the most frequent injuries of the foot skeleton. Nondislocated fractures can be conservatively treated with good success. Long-term relief and immobilization including the ankle joint are unnecessary. ⋯ The correct classification is necessary in order to initiate an adequate treatment. In general, intra-articular layer formation, inclination >10° and shortening between 3 mm and 5 mm, taking the position of the head of the metatarsal bone into consideration, are recommended as indications for surgery. Operative treatment of toe fractures is only rarely necessary.
-
The most important goals of scaphoid reconstruction in pseudarthrosis are correction of the humpback deformity, the realignment of the proximal carpal row and the bony union of the scaphoid. Therefore, in most cases bone grafting is required. To increase the healing rate and to improve vascularization, several kinds of vascularized bone grafts have been developed. ⋯ The use of vascularized grafts is still a matter of controversy, since their superiority is still unproven compared to nonvascularized grafts, which also achieved 100% fusion rates in several series. They are indicated in secondary procedures after failed reconstruction and nonunion with small avascular proximal pole fragments. Since no evidence-based guidelines exist, this article provides an experience-based treatment algorithm for scaphoid nonunion with special consideration to vascularized bone grafts.
-
Untreated scaphoid nonunion as a rule results in subsequent scaphoid nonunion advanced collapse (SNAC) wrist. While reconstructive treatment of the scaphoid in association with resection of the styloid process of the radius is still promising in stage I SNAC wrist, salvage procedures are available for higher degrees of SNAC wrist to reduce pain and to preserve the function of the wrist. Denervation, proximal row carpectomy and partial wrist fusion maintain wrist mobility. Total wrist arthrodesis and total wrist arthroplasty are salvage procedures in cases of panarthritis or failed motion-preserving procedures.