Der Unfallchirurg
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Fractures of the odontoid process represent about 10-20% of all diagnosed cervical spine fractures. Approximately 35% of these fractures are classified as Type II according to Anderson and D'Alonzo. They can be potentially unstable especially if combined with a dens displacement of over 6 mm. ⋯ These patients can present without significant neurological deficits or the situation can be complicated due to intoxication or additional trauma. Under these circumstances in particular, the diagnosis can be delayed or missed, if no strict protocols for diagnostic effort in all whiplash injuries are employed. A case of delayed diagnosis of an odontoid fracture in a neurological asymptomatic patient after whiplash injury is presented.
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Case Reports
[Fatal soft tissue infections after arthroscopy of the knee joint. A diagnostic or therapeutic problem?].
After detection of a bacterial infection of the joint, an absolute indication for intervention is given. Systemic antibiotic drug therapy is indicated and drainage of the joint has to be performed immediately. The following therapeutic algorithm regimen is a proven remedy in treating pyoarthrosis of the knee joint: During the initial period, the infection can be controlled by arthroscopic irrigation and systemic antibiotic therapy. ⋯ If open joint revision including synovectomy is not performed or is performed too late, there will be a threat of irreversible damage of the afflicted joint up to septic spread endangering the patient's life. We report on two patients suffering from generalized sepsis resulting in death after delayed therapy for knee joint infection. Regarding the presented cases, it can be concluded that indication to early surgical joint debridement including open synovectomy of the knee is still rarely seen after development of pyoarthritis.
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Comparative Study Clinical Trial
[Stable and unstable pertrochanteric femoral fractures. Differentiated indications for the dynamic hip screw].
The aim of all surgical procedures in the treatment of trochanteric fractures in elderly and even geriatric patients is achievement of initial stability. We examined in a clinical trial whether primary stability was achieved in all types of trochanteric fractures following osteosynthesis with the Dynamic Hip Screw (DHS). From 1994 to 1996, 122 patients with trochanteric fractures had osteosynthesis by dynamic hip screw. ⋯ Assessment of the functional outcome according to THRS showed a significant deterioration of 20 points in 71% of all patients compared with the preoperative score. The results show that dynamic hip screw osteosynthesis in instable trochanteric fractures is associated to a higher incidence of complications. While the dynamic hip screw still represents the standard implant in stable fractures of the trochanteric region, being aware of improved intramedullary implants regarding biomechanical features and surgical technique, the results justify to critical consider the use of DHS for osteosynthesis in instable fractures of the trochanteric region.