Der Unfallchirurg
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Brachial plexus lesions mostly occur in young patients as a result of high-speed accidents. They are often diagnosed and treated after a delay. ⋯ In 70-80% of traumatic lesions functional reinnervation can be achieved by various surgical procedures. An early sufficient diagnosis and the subsequent referral of the patient to an appropriate competence center for consultation and, if necessary, surgery are therefore essential.
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There still is no standard therapy that predictably results in healing of avascular necrosis of the lunate bone. Nevertheless, there exists a wide spectrum of operative treatment options for different stages. ⋯ According to the presented algorithms a stage-dependent therapy of necrosis of the lunate bone is possible. It should not be ignored that there are still no scientific and evidence-based arguments for some of these treatment options. This is also true for maximally invasive procedures, where superiority to more simple procedures have not been proven. Therefore, their application should be restricted and based on an individual decision.
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Complete rupture of the scapholunate (SL) ligament can cause a dissociative carpal instability (CID). These ligamentous lesions are caused by a fall from a limited height of approximately 1 m or a fall, e. g. when playing handball or soccer. For a freshly injured wrist joint, the X‑ray signs of a static instability (after excluding a fracture) are a SL distance ≥3 mm, a SL angle >60°, and a dorsal displacement of the proximal scaphoid pole. ⋯ The cornerstone of the procedure is an anatomic reduction of the SL joint stabilized with K‑wires for 8 weeks. In older lesions, ligament transfer or ligamentoplasty using a tendon transfer may add to stability but have so far not achieved a reliable joint alignment despite usually good functional results. It appears that the reduction of the proximal scaphoid pole deserves more attention.
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Perilunate injuries are one of the most severe injuries of the hand. They occur relatively rarely but necessitate that diagnostic procedures should be carried out thoroughly and as soon as possible. The therapeutic strategy must consider the age, exact type and full extent of the injury. The key for successful treatment is exact anatomic reduction and stable fixation of all injured structures.