Der Unfallchirurg
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Inadequate treatment of distal intra-articular fractures of the humerus results in painful restriction of movement or malarticulation. Especially in geriatric patients with osteoporosis, stable osteosynthesis can be difficult. Primary total endoprosthetic replacement of the cubital joint could offer an alternative. ⋯ In elderly patients primary endoprosthetic treatment of a distal intra-articular fracture of the humerus with a semi-constrained cemented prosthesis may offer an alternative to osteosynthesis thus enabling creation of a mobile, painless and stable cubital joint.
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[Operative treatment of instable osteoporotic spine fractures. A good guide in coding of diagnosis].
The combination of kyphoplasty and fixateur interne is an essential therapy with osteoporotic unstable fractures. Material costs of 5500 Euro are not sufficiently covered by returns through DRG I09. Thus operations are often performed in 2 stages, an initial one and a second 30 days later. ⋯ Prerequirement is coding of kyphoplastiy as main procedure and percutaneous implantation of a fixateur with procedure 5-835.5. Some procedures in orthopedic surgery implying technical improvements and rising implant costs are not sufficiently rewarded. Thus is make sense to inform InEK by corresponding proposals.
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The diagnostic and treatment of a closed avulsion of the flexor digitorum profundus muscle at its insertion of the little finger is presented. This happened as a 41-year-old woman wanted to hold a dog lead in her left hand and suddenly the dog started to run. ⋯ In the case described here there was no torn fragment at the distal end of the FDP tendon and the bone structure of the phalanx distales was intact. The operative treatment, postoperative care and clinical course are presented.
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Various treatment options have been proposed for reconstruction of the scapholunate ligament. However, none of these methods prevent patients with scapholunate instability from developing wrist arthritis. This study was performed to investigate a new bone-ligament-bone autograft from the plantar plate of the toes for suitable reconstruction of the scapholunate interosseus ligament. The anatomical properties and the technical feasibility were investigated. ⋯ It can be concluded from the data that this new graft of the proximal interphalangeal joint of the 3rd and 4th toes can be a suitable replacement for the scapholunate ligament.
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We report the case of a 73-year-old male patient who was suffered trauma after a syncopal fall onto a railway track in the form of an atlanto-occipital dislocation. The diagnostic revealed a bilateral fracture of the occipital condyles coupled with a ventral atlanto-occipital dislocation (Jeanneret type 4) and also an odontoid fracture (Anderson type 2). ⋯ Pre-operatively and postoperatively no neurological abnormalities were found. This rarely occurring and survived traumatological situation is described using the present case as an example.