Der Unfallchirurg
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The process of reduction is a key step for successful fracture treatment. The goal of fracture reduction is the realignment of the displaced fractured fragments caused by muscle tension or impaction back into the original anatomic relationship. The reduction process includes not only the application of force at or remote from the fracture site to reverse the deforming forces but also the preoperative planning where to apply these forces and by what means. Furthermore, consideration should be preoperatively given on how to position the patient and the C‑arm and how to temporarily maintain reduction for intraoperative x‑ray control of the axis, rotation and lengths before definitive fixation.
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The cornerstones for treatment of articular fractures are gentle handling of soft tissues and anatomical reconstruction of the articular surface with stable fixation, which enables a functional aftercare. By respecting these principles, satisfactory functional and radiological results with low complication rates can be achieved even for complex fracture patterns. Fracture complexity varies with the energy load during the trauma mechanism. ⋯ Successful fracture management depends on individualized decision making with respect to optimal timing of the operative intervention, reconstruction strategy of the articular surface, choice of surgical approach, reduction maneuver technique and choice of implant. This strategy must be adapted to individual-specific fracture patterns and the patient's general condition. The aim of this article is to provide an overview of the strategy and technique in management of articular fractures, with the main focus on reduction maneuver techniques.
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Previous studies on orthogeriatric models of care suggest that there is substantial variability in how geriatric care is integrated in the patient management and the necessary intensity of geriatric involvement is questionable. ⋯ There was a clear tendency to a better overall result in patients receiving multidisciplinary orthogeriatric treatment using a ward visit model of orthogeriatric comanagement, with lower rates of cardiorespiratory complications and mortality. While special care pathways could reduce the rate of myocardial infarction in hip fracture patients, costs and revenues showed no difference between all care models evaluated. However, patients with hip fracture or periprosthetic fracture represent cohorts at clinical and economic risk as well.
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The development of emphysema after intramedullary nailing can represent an easily manageable complication but in the differential diagnostics it could, however, be a life-threatening infection with Clostridium perfringens. This is a report about the case of an extensive subcutaneous and retroperitoneal emphysema, which developed after intramedullary nailing of a pertrochanteric femoral fracture and where such an infection was suspected.
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Intramedullary nailing was originally conceived for the stabilization of shaft fractures of long bones. Due to new nail designs and multiple interlocking possibilities, the spectrum of nailing has significantly increased. Nailing of fractures beyond the isthmus is technically challenging because fractures need to be reduced before the nailing procedure starts. ⋯ Blocking screws create an artificial isthmus in the metaphyseal area and force the guide wire in the desired direction. Blocking screws help to avoid axial malalignment during nail insertion. Interlocking of the nail with screws coming from different directions prevents secondary dislocation.