Der Unfallchirurg
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Severely injured children and adolescents in clinical practice are rare. For adequate treatment of these patients, detailed knowledge of anatomical and physiological peculiarities, as well as abundant injury patterns, are indispensable. Traumatic brain injuries are known to lead to an unfavorable outcome. In addition, thoracic trauma is regarded as prognostically unfavorable. ⋯ Thoracic trauma is a relevant factor in children with regard to the severity of total injury and complications. Particular attention should therefore be paid to early diagnosis and treatment.
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This case report describes a 55-year-old male patient with type II necrotizing fasciitis (NF) of the hand and forearm. The rapid progression of the tissue infection could be successfully stopped with radical surgical débridement and antibiotic therapy. For the reconstruction of the extensive loss of soft tissue a combination of split-thickness skin graft (STSG) and the synthetic dermal substitute MatriDerm® was used. In cases of NF, MatriDerm® and STSG provide a rapidly available and simple alternative to other reconstruction techniques.
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In contrast to shoulder dislocations in younger patients, anterior shoulder dislocation in the elderly is often associated with concomitant injuries to the rotator cuff and fractures. There is also frequent involvement of the brachial plexus or peripheral nerves. After closed reduction and a short period of immobilization, physiotherapy should be performed to restore mobility and strength. ⋯ Elderly patients with accompanying rotator cuff lesions and failed conservative therapy can benefit from a surgical intervention. Reconstructive interventions of the rotator cuff should be principally considered; however, some individuals may benefit from a reverse prosthesis in this elderly subgroup of patients. The challenge for the treating surgeon is to exactly define the structural injury of the shoulder (which may include pre-existing lesions) and to select the optimal treatment option.
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Review
[Bony Bankart lesions and glenoid defects : From refixation techniques to bony augmentation].
Rim defects of the anterior glenoid cavity are a main reason for residual shoulder instability after traumatic dislocation of the shoulder. These defects can be the result of a glenoid rim fracture or chronic glenoid erosion after repeated shoulder dislocations. ⋯ The purpose of this article is to summarize the diagnostics and indications for treatment of glenoid rim fractures. Radiological assessment and options for augmentation are reviewed for both acute fractures as well as chronic instability following an anterior glenoid rim defect.
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Arthroscopic soft tissue stabilization is a well-established and broadly accepted procedure to treat posttraumatic shoulder instability. Advantages in comparison to open stabilization procedures include improved visualization of the structural damage and a less invasive approach. ⋯ Modern suture anchor systems to achieve arthroscopic stabilization with the corresponding advantages and disadvantages are also presented. Furthermore, the limitations and long-term results of arthroscopic soft tissue stabilization are discussed.