Der Unfallchirurg
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Correct aftercare following lower extremity fractures remains a controversial issue. Reliable, clinically applicable weight-bearing recommendations have not yet been defined. The aim of the current study was to establish a new gait analysis insole during physical therapy aftercare of ankle fractures to test patients' continuous, long-term compliance to partial weight-bearing restrictions and investigate whether patients can estimate their weight-bearing compliance. ⋯ Standardized aftercare protocols and repeated training alone cannot ensure compliance to postoperative partial weight-bearing. Patients unconsciously increased weight-bearing based on their pain level. This study shows that new, individual and possibly technology-assisted weight-bearing regimes are needed. The introduced measuring device is feasible to monitor and steer patient weight-bearing during future studies.
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At present, there is a high percentage and increasing tendency of patients presenting with orthogeriatric injuries. Moreover, significant comorbidities often exist, requiring increased interdisciplinary treatment. These developments have led the German Society of Trauma Surgery, in cooperation with the German Society of Geriatrics, to establish geriatric trauma centers. ⋯ A network structure can be an alternative to classical cooperation between trauma and geriatric units in one clinic and help reduce possible staffing shortage. Due to the lack of scientific evidence, future evaluations of the geriatric trauma register should reveal whether network structures in geriatric trauma surgery lead to a valid improvement in medical care.
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Rotational malalignment after intramedullary nailing of tibial shaft fractures is not uncommon. In-toeing and out-toeing conditions in children are often the reason for orthopedic and traumatological medical consultation. ⋯ If there is a suspicion of rotational malalignment in the lower leg, a CT scan can be performed in adults and MRI in children and adolescents. Surgical indications for corrective osteotomy are dependent on functional complaints as well as the CT and MRI measurements. The CT and MRI reference values are only published according to the method of Waidelich et al. and Jend et al.
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Review Meta Analysis
[Suitability of computer-assisted femoral intramedullary nailing for control of torsion and length : Systematic review of clinical studies].
Despite promising results in experimental studies, computer-assisted femoral intramedullary nailing has not become established in the clinical practice for most orthopedic surgeons. The purpose of this study was to evaluate the advantages and disadvantages of computer-assisted reduction and nailing of femoral fractures as reported in clinical studies. ⋯ Our analysis could show that computer-assisted femoral intramedullary nailing is clinically feasible but the operative and fluoroscopy time needed are high and the reported postoperative results for femoral length and torsion were very heterogeneous. Further comparative studies are needed in the future.