Der Unfallchirurg
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Case Reports
[Lateral tibial head fracture and avulsion fracture of the tibial tuberosity: a rare combination of injuries].
The rare combination of a lateral tibial head fracture and an avulsion fracture of the tibial tuberosity requires treatment that differs from the therapy of the single occurrence of each of these injuries. Especially postsurgical treatment is not yet standardized. ⋯ We performed a multimodal osteosynthesis followed by postsurgical treatment which is different from the postoperative treatment for the individual injuries: immobilization of the knee joint with a thigh splint for 6 weeks, isometric physical therapy, and prohibition of movement in the knee for 4 weeks. This therapy appears to be an effective and successful approach for this combination of injuries, where no standardized treatment has been established yet.
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Can additive fiber cerclage (FC) reduce secondary displacement in unstable 3-part proximal humeral fractures stabilized by angle-stable plates? Is there any effect of different head screw configurations? ⋯ In cases of anatomical reduction and optimally placed implants, FC did not show an additional stabilizing effect in the unstable 3-part fracture model. Different head screw configurations did not influence stability.
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Case Reports
[Cerclage using hollow screws for internal arthrodesis in cases of pronounced osteoporosis and osteopenia].
Osteosynthesis of osteoporotic or osteopenic bone poses a considerable challenge for the surgeon, the type of osteosynthesis performed, and the osteosynthesis material employed. In osteoporotic and osteopenic bone, especially when circulation is decreased or sensitivity reduced, the principle of tension banding places great demands on the bone and surgeon since insufficient tightening of the wire results in inadequate immobilization while overtightening of the tension band can cause the wire to cut through the soft bone. This contribution describes a surgical technique, which prevents the wire from cutting through the bone. ⋯ This ensures that the wire traction is distributed across the entire cross section of the bone. Thus, it is possible to completely tighten the tension band in osteopenic and osteoporotic bone. This technique is illustrated using the example of internal screw and tension band arthrodesis of the ankle joint, which achieved stable arthrodesis with weight bearing and recovered ambulation in a patient with pronounced diabetic foot syndrome and peripheral arterial occlusive disease.