Der Unfallchirurg
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Insertion of titanium nails for type A and B clavicular fractures can fail intraoperatively due to the small diameter or irregular nature of the medullary canal. At present, such failures lead to open reduction and fixation (ORIF) with plates. In type C fractures (comminuted fractures), a telescoping effect is observed so that ORIF is the only suitable alternative besides nonoperative therapy. A suitable minimally invasive solution for type C fractures and as a salvage procedure for failed intramedullary nailing of type A and B fractures is presented here for the first time with a percutaneous application of an LC plate to the clavicle.
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While the number of fatal accidents decreases every year, there is still need for improvement and action to prevent these deaths. The basis for this purpose has to be an analysis about the factors influencing the car crash mortality. ⋯ Univariate assessments may be falsified by bias; this effect can be uncovered by multivariate models.
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Chopart amputation leaves a very efficient hindfoot stump allowing full plantigrade weightbearing, even without an artificial limb in place for short distances. It must be said that this presupposes that the sole is covered with skin originally taken from the sole of the foot and that the tread of the heel is correct. ⋯ Weightbearing was not possible, and constant ulcers entailed frequent periods of unfitness for work, so that he expressly requested below-knee amputation at first. Correction of the equinovarus deformity by tibiocalcaneal arthrodesis using intramedullary nailing led to lasting healing of the skin and the possibility of full weightbearing.
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Clinical Trial
[Closure of defects on the dorsum of the foot with free flaps. Functional and aesthetic aspects].
Large complex soft-tissue defects on the dorsum of the foot, with exposed tendons, joints, bones, nerves and vessels, have to be reconstructed by transplantation of free tissue grafts with good blood flow. ⋯ Free muscle flaps with skin grafts, particularly the free gracilis muscle flap, are superior to fasciocutaneous flaps and perforating flaps in aesthetic outcome and donor site morbidity.
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Case Reports
[Percutaneously navigated balloon fracture reduction in a displaced acetabular fracture].
Kyphoplasty is a well proven surgical procedure for osteoporotic fractures in spine surgery. Anatomic reconstruction of the joint is the primary aim in the treatment of acetabular fractures. To achieve this, extensive approaches with entry related morbidity are usually needed. ⋯ After 2D C-arm controlled fracture reduction, the supra-acetabular screw was inserted percutaneously using the previous 3D navigation data set. With the combination of kyphoplasty technique, intraoperative 3D C-arm control and 3D C-arm based navigation, this displaced acetabular fracture could be reduced and fixed percutaneously. Anatomic reconstruction of the joint remains the primary aim.