Der Unfallchirurg
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Osteoarthritis of the knee is often diagnosed in the orthopedic trauma practice. One major cause is axial deformity with overload. In the case presented here osteomyelitis of the tibial diaphysis developed in childhood. ⋯ In this way it was possible to eradicate the osteomyelitis of the lower leg and to achieve osseous consolidation between the tibia and fibula. Despite the significant shortening of the lower limb and the varus axial deformity, the knee joint function was satisfactory in the subsequent development. After a long interval without symptoms the patient developed a medially accentuated osteoarthritis of the knee.
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Thoracic inlet syndrome is a rare venous obstruction of the upper extremity caused by narrowness of the costoclavicular angle. This case report describes an obstruction of the vena subclavia after percutaneous elastic stable medullary nailing of a comminuted fracture of the clavicle.
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The endoprosthetic replacement of the hip joint or its components in fractures of the proximal femur is a standard method. Indications for replacement are strongly dislocated intracapsular femoral neck fractures in elderly patients, fractures with an existing arthritis of the hip joint, and profound osteoporosis. Improved perioperative management and more gentle anesthetic techniques have helped to reduce perioperative mortality from nearly 50% to 11.5% over the last 40 years. ⋯ Despite the high standard of endoprosthetics in Germany, the results are still improvable in comparison to other countries. Measures which preserve the joint as well as the bone will be increasingly important in prophylaxis of further complications. In addition, more attention should be paid to the prophylaxis of falls and a sufficiently guide-lined therapy of osteoporosis for the prophylaxis of fractures of the elderly.
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Intraoperative 3-D visualization using the Siremobil Iso C(3D) (Siemens, Erlangen, Germany) has been approved for use in spine and long bone surgery since its recent clinical launch. In preparation for the clinical use of the Siremobil Iso C(3D) in pelvic surgery, the aim of this study was to grade the quality of visualization in comparison with the gold standard of computer tomography in four therapy relevant pelvic regions in eight human cadavers, including SI screws to exemplify implants in the dorsal pelvic ring. Besides the influence of the body mass index and the interference of metal artefacts, visualization quality was evaluated in different pelvic regions (sacroiliac joint, acetabulum, femoral neck and anterior pelvic ring) using a score with five subgroups, rating the applicability of Siremobil Iso C(3D) in pelvic surgery. ⋯ Implants positioned in the dorsal pelvic ring reduced visualization quality, but sufficient estimation of bony structures was still possible. For primary diagnostics, computer tomography remains a clearly superior option due to better image quality. For intraoperative control of the reduction and positioning of implants in pelvic surgery, however, the additional intraoperative use of Siremobil Iso C(3D) is considered to offer clear advantages over current 2-D C-arm visualization tools.