Der Unfallchirurg
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Fractures of and near the epiphysis occur much less frequently in the lower extremities than in the upper extremities. The time required for consolidation of lower extremity fractures is twice as long as for fractures of the arm or hand. ⋯ Additionally, deformities of the lower extremity skeleton result in a more severe functional impairment than would result from epiphyseal fractures of the arm or hand (with the exception of injuries to the elbow). Therefore, proper radiographic diagnostics with precise projection of the required planes are mandatory to accurately determine all further treatment options.
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The treatment of fractures of the medial malleolus in juveniles is of particular relevance. In patients under 10 years old fractures of the distal tibia affect almost exclusively the medial malleolus in the extension line of the medial talus edge in a proximal direction. ⋯ When fractures of the medial malleolus remain unrecognized or are treated inadequately, growth disturbances can occur (e.g. excessive or reduced growth, axis deviation). The diagnostics, indications (conservative or surgical treatment), treatment and follow-up care must be discussed and the corresponding legal aspects must be taken into consideration.
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Clinical Trial
[Operative treatment of traumatic fractures of the thorax and lumbar spine. Part II: surgical treatment and radiological findings].
The Spine Study Group (AG WS) of the German Trauma Association (DGU) presents its second prospective Internet-based multicenter study (MCS II) for the treatment of thoracic and lumbar spinal injuries. This second part of the study report focuses on the surgical treatment, course of treatment, and radiological findings in a study population of 865 patients. A total of 158 (18,3%) thoracic, 595 (68,8%) thoracolumbar, and 112 (12,9%) lumbar spine injuries were treated. ⋯ The most common postoperative complication was associated with wound healing problems in 14 (1,9%) patients. Except in the non-operative treatment subgroup, a correction of the posttraumatic measured radiological deformity was achieved to a different extent within every treatment subgroup. There were no statistically significant differences between the postoperative radiological results of the treatment subgroups (dorsal vs. combination), taking into consideration the influence of relevant parameters such as different fracture types, patient age, and the amount of posttraumatic deformity (p=0,34, ANOVA).