Der Unfallchirurg
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Case Reports
[Tibial tuberosity avulsion fracture and posterior fracture of the proximal tibial epiphysis].
Avulsion fractures of the tibial tuberosity are rare. In general, juvenile male athletes sustain this fracture. A combination of Ogden type 3A fracture in combination with a posterior fracture of the proximal tibial epiphysis type Salter 2 is described for the first time. The necessity for immediate surgical intervention to prevent secondary soft tissue injury is stressed.
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Blast injuries of the hand represent a demanding surgical emergency for the reconstructive hand surgeon. Commercially available fireworks are often regarded as less dangerous compared to combat ammunition, but the following examples demonstrate their real potential for devastating hand injuries. Some of the closed injuries can represent a pitfall for correct assessment of trauma severity. ⋯ Blast injuries of the hand need a fast, strategically planned surgical approach. This is also true for presumably harmless, CE-certified fireworks. In a multiple patient scenario, triage based on surgical urgency may be necessary. A detailed clinical examination and surgical exploration is mandatory to avoid possible pitfalls like in closed injuries. Profound skills in reconstructive and microvascular hand surgery are essential to achieve an optimal clinical outcome.
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Vertebroplasty and kyphoplasty are being increasingly used in the treatment of osteoporotic vertebral body fractures. Shortening the duration of operative time and radiation exposure as well as reduction of cannulation-related risks and costs are advantages of the unipedicular technique in contrast to less homogeneous cement distribution as a possible disadvantage. Biomechanical investigations have shown similar results with respect to strength and stiffness both for uni- and bipedicular vertebroplasty. Studies evaluating cement distribution with CT scans using a unipedicular approach have not been published yet. ⋯ Unipedicular vertebroplasty using a modified approach permits a reliable placement of the needle into the middle third of the vertebral body, which is the optimal position regarding cement distribution. Unipedicular vertebroplasty allows homogeneous filling and augmentation of vertebral bodies without need for a second cannulation.
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Multislice computed tomography (CT) technology has improved the diagnosis of relevant lesions within the phase of primary treatment of severely injured patients. The lack of time in this phase and the complexity of the multiple injuries there is still a risk that lesions will be missed at this stage. The purpose of this study was to evaluate the incidence, causes, implications and significance when injuries are not diagnosed until later. ⋯ Despite intensified and standardised diagnostic procedures prescribed for use in trauma centres, injuries are still missed in severely injured patients. About 30% of lesions that are not diagnosed until after the patient has left the emergency room have clinically significant, but not lethal, consequences for the patient. Great importance attaches to the follow-up investigation on the intensive care station, so that lesions that have initially been overlooked can be diagnosed and treated as soon as possible so as to keep the complication rate low.
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Intra-articular distal humerus fractures are relatively uncommon. Due to osteoporosis in elderly patients, stable fixation still remains a problem despite new implants providing angular stability. ⋯ We have used this technique on ten patients aged 76.2 years (range 67-88 years). According to the AO classification, there were three B-1/B-2 fractures, four C-1 and three C-2/C-3 fractures without severe comminution. The duration of external fixation was 6.3 weeks (range 4-8 weeks) before fracture union was achieved. This allows the initiation of physiotherapy and motion of the elbow. There was only one revision caused by the necessary replacement of an aseptic loosened Schanz screw. At follow-up 3 months postoperatively, the range of motion of the elbow was 95 degrees (65 degrees-105 degrees ), average extension 25 degrees (10 degrees-35 degrees ) and mean flexion was 115 degrees (100 degrees-120 degrees ) with all patients exhibiting full pro/supination.