Der Unfallchirurg
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A 32-year-old man had fallen from an 8-m high scaffolding and had suffered multiple traumatic injuries, such as compression fractures of the thoracic vertebrae (TV) 5-7 without incarceration of the spinal canal plus a distal femoral fracture. During surgery on the day of the accident, spondylodesis and dorsal stabilization of TV 4-7 using an internal fixator were carried out and the distal femoral fracture was stabilized with a dynamic condylar screw (DCS). On the day following the accident, the malposition of a pedicle screw located at the height of TV 4 and the borderline malposition of a pedicle screw of TV 7 were corrected. ⋯ No organopathy could be noticed which could have explained the sudden vision loss. A study of the literature was done, using the keywords "blindness" and "spine surgery." Only very few cases describing a connection of spine surgery and postoperative vision loss could be found. This article aims to elaborate on the few connections worked out in these investigations.
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Clinical outcome following pelvic ring fractures of AO/OTA type-A in the elderly is often unsatisfying because the posterior pelvic ring fracture is underdiagnosed and patients with type B fractures were conservatively treated like patients with type A fractures. This so-called "A-B" problem was systematically analyzed in our patients with pelvic ring fractures. 183 patients were treated with pelvic ring fractures. Primarily, the injuries were classified as follows: 81 type A, 38 type B, and 64 type C. ⋯ The treatment consisted in a supra-acetabular external fixator for an average of 3 weeks. After 4 weeks the mean pelvis outcome score was 9 (7-10) points. In cases of persistent pain for more than 2 weeks after transpubic pelvic ring fractures in the elderly further investigation by CT scan should be recommended to exclude a concomitant sacral fracture, which then could be safely treated by a supra-acetabular external fixator.
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Full thickness defects of the articular cartilage in the knee joint have lower regenerative properties compared to chondral lesions of the ankle. In order to avoid early osteoarthritis, symptomatic articular cartilage defects in younger patients should undergo biological reconstruction as early as possible. There are different surgical procedures available to achieve a biological resurfacing of the articular joint line. ⋯ The different surgical procedures can be differentiated concerning the various indications and the final outcome. Additional malalignment, meniscus tears, and/or ligament instabilities should be treated simultaneously together with the cartilage resurfacing. The mid- and long-term results of the different current techniques are promising, but further modifications and improvements are needed.
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Modern molecular and genetic technologies enable the modification of a cellular genome through transfer of specific genes. The various procedures alter specific cell functions, which allow the transfected cell to produce any encoded transgene information. ⋯ Currently, further animal studies are evaluating new vectors with reduced immunogenicity in the continuous effort to improve the efficacy and safety of gene transfer. In the forthcoming decade we expect gene therapy to have an important influence on the treatment of fractures, cartilage lesions, and infection.