Der Unfallchirurg
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Patients suffering from sickle cell disease show an increased ischemic intolerance due to continuous pro-inflammatory activation and dysfunction of the endothelium by recurrent vaso-occlusive episodes. The presented case shows the manifestation of a postoperative compartment syndrome of the lower leg following the intraoperative use of blood arrest in a patient with previously unknown sickle cell disease. Preexisting vulnerability for tissue hypoxia in patients at risk should be a major concern for intraoperative use of blood arrest during surgery of the extremities.
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For many years, resection was the only therapy used for comminuted fractures of the radial head. When associated with an injury of the collateral ligament, the outcome was often unsatisfactory. Implantation of the modern radial head prosthesis promises a better outcome. ⋯ Arthroplasty with a modular metallic radial head combined with ligament reconstruction is an effective alternative to radial head resection. Compared with resection, the results using the EVOLVE prosthesis demonstrate definite advantages with regard to clinical outcome.
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Neonatal traumatic epiphyseolysis of the humeral head is rare, and only a few cases are reported in the literature. We present a case of a 13-day-old female newborn with malposition and relaxation of the left upper limb. The clinical examination showed distinct range of motion particularly for abduction. ⋯ This status was not followed by renewed repositioning. The x-ray examination 5 months later and MRI 9 months later showed a centered position of the epiphysis. In conclusion, neonatal traumatic epiphyseolysis of the proximal humeral head occurs rarely but should be considered, particularly with unclear relaxation of the limb.
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Combined forearm fractures are identified according to their location as Galeazzi, Monteggia, or Essex-Lopresti injuries. The feature common to these three forms is the combination of a forearm fracture with instability of the distal or proximal radioulnar joint. Appropriate management of the injury at an early stage is indispensable to achieve good functional results. ⋯ Essex-Lopresti injuries are treated by surgical reconstruction of the radial head, and in cases of comminuted fractures by implanting a radial head prosthesis. Subsequent treatment entails at least 14 days immobilization in a supinated position using an upper arm cast. Early functional therapy should follow when all three forms of injuries have been treated.
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Type B injuries of the thoracolumbar spine (AO classification) indicate the need for surgical treatment. Type B1 injuries include disruption of the posterior ligament complex (PLC), which can be underdiagnosed when using x-ray and CT. The aims of this study were to determine the frequency of misclassification to compile similarities of type B1 injuries. ⋯ Type B injuries are frequently misinterpreted. To achieve a correct diagnosis, all clinical and radiological signs must be considered. 29% of all type B1 injuries cannot be detected on x-ray or CT scan.