Der Unfallchirurg
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Dislocation of the patella is one of the most common knee injuries in childhood and adolescence. After detailed clinical and radiological clarification, conservative functional treatment with special orthotic devices is most commonly applied in patients with a primary dislocation without concomitant injuries; however, the redislocation rate after conservative treatment has been reported in the literature to be between 35% and 70%, depending on the risk factors present. ⋯ Many scientific contributions on the topic notably in the last two decades have increased the understanding of patellofemoral instability. The comprehensive knowledge of the causes for a persisting instability of the patella has made the treatment more efficient and precise but also more complex.
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Fractures in childhood can result in malalignment and/or leg shortening due to insufficient reduction, malunion or injury to the growth plate. ⋯ Precise analysis of the deformity and leg length discrepancy is necessary to select the best point in time and the right surgical procedure and hardware for correction.
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Review
[Anterior cruciate ligament rupture in children with open growth plate : Diagnostics and treatment].
Anterior cruciate ligament (ACL) ruptures in pediatric patients with open growth plate are of concern and the number of injuries is increasing. The possibilities for diagnostics using magnetic resonance imaging (MRI) have improved and are without radiation exposure to the growing skeleton. The MRI should be performed routinely in every case of adequate trauma also to recognize additional injuries to the knee joint. ⋯ Despite the different surgical techniques, the general recommendation is for replacement of the ACL. Extensive procedures with an increased risk of epiphyseal injury should be avoided and anatomical techniques should be preferred. The results are good to very good and with adequate knowledge of the special features of children, complications are rare.
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Every year up to 35,000 people in Germany are severely injured in accidents in traffic, during work or leisure activities. The 24-h availability of the trauma room as well as surgical and intensive care unit capacities are essential to provide optimal acute care. This study analyzed the frequency of utilization of the resource trauma room in a level I trauma center in the past. ⋯ The data at hand showed a constant number of severely injured trauma patients admitted to a level I trauma center over the past few years. At the same time, there was a significant increase in utilization of the trauma room; however, in a considerable number of patients admitted to the trauma room the diagnostic process resulted in non-traumatic diagnostic findings. In the analyzed cohort, especially patients admitted to the trauma room due to trauma mechanism or without an accompanying emergency physician contributed to this development, necessitating an increased operational readiness of the trauma room team.
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Case Reports
[Isolated fracture of the coracoid process in a 14-year-old national water polo player : Case example].
Isolated fractures of the coracoid process during sporting activities are very rare. There are a few case studies and retrospective studies with low numbers of cases. ⋯ In cases with therapy refractory shoulder pain after trauma and unremarkable native X‑ray, extended 3D imaging by magnetic resonance imaging (MRI) or computed tomography (CT) should be done early. Conservative therapy of a non-dislocated fracture in this case showed a good outcome.