Der Unfallchirurg
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Review Meta Analysis
[Fractures of the neck of the femur in younger patients (15-50 years old). Systematic literature research on medial fractures of the neck of the femur in young patients].
Non-pathologic fractures of the neck of the femur in younger patients aged between 15 and 50 years old are rare injuries. These are so-called effectual injuries with very high energy induction due to traffic accidents, falls and sport accidents, causing healthy bones to be fractured and often leading to multiple injuries. The short-term and long-term complications of such injuries sometimes give rise to substantial problems, in particular from non-union fractures and avascular necrosis of the head of the femur. ⋯ This presentation has gone so far that in some cases the term "treatment malpractice" has been used in legal disputes (and judgments) (Judgment IU 5146/00, Higher Regional Court Munich; 2O 861/07 Hei, Regional District Court Ansbach; 118C 421/05, District Court Cologne). The authors have often been called upon as medical experts to comment on the current state of medical knowledge on the question of the biology of healing of fractures of the neck of the femur and the question of"verified" therapy strategies. With this in mind this article is designed to give a review of the current state of proven knowledge according to the available clinical and experimental data and last but not least to stimulate constructive discussion.
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Review Case Reports
[Recurrent synovial chondromatosis of the tarsometatarsal joint. Case report and review of literature].
Primary synovial chondromatosis is a rare and usually monoarticular metaplasia of the synovia. It may recur, but the tendency to malignant transformation is very low. The radiological and histopathological differentiation from low grade chondrosarcoma can be difficult. We present a case report of a 32-year-old male with synovial chondromatosis in the tarsometatarsal joint area, which is an uncommon localization.
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The precision of sacroiliac screw placement can be improved with the use of navigation techniques. The purpose of this study was to evaluate the accuracy of 3D-navigated sacroiliac screw positioning in relation to the surgeon's experience with the navigation technique. ⋯ In the clinical setup a malpositioning of sacroiliac screws is possible even with the use of 3D navigation. One reason may be a low level of navigation experience of the surgeon in combination with low experience in the conventional technique. Therefore even in navigation-based placement of sacroiliac screws the malpositioning rate is dependent on the surgeon's experience with the navigation technique. The correct placement of the screws should be controlled intraoperatively using the 3D image intensifier.
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Case Reports
[Therapy-resistant tibial pseudarthrosis. Treatment success with BMP-7 combined with autologous bone].
Delayed union or non-union of long bone shaft fractures still presents a surgical challenge. Especially if there is a predisposition for pseudarthrosis such as adiposity, diabetes mellitus, local disruption of blood supply or lack of hormones, the established procedures of autologous cancellous bone grafting or plate fixation with compression often lead to insufficient results. ⋯ In a patient with multiple risk factors the tibial fracture was completely cured after two attempts of osteosynthesis and autologous bone grafting had failed. The patient achieved self-mobility with full weight bearing and absence of pain 10 months after adjuvant implantation of BMP-7.
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The prognosis of severely injured patients depends on a rapid diagnosis and early initiation of therapeutic procedures. ⋯ The duration of time intervals depends on injury severity, treatment after completion of emergency trauma care and the level of the trauma centre. Time management in emergency trauma care can potentially be optimized after completion of the last diagnostic procedure in the emergency room.