Der Unfallchirurg
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From 1977 through 1992 a total of 25 children (age 4 months to 14 years) were hospitalized for pelvic fractures. Clinical outcome and X-ray evaluation had been recorded and were retrieved for 21 children. ⋯ All pelvic fractures healed uneventfully whether treated by surgery or conservatively. Concomitant injuries, treatment, and types of pelvic fracture are discussed.
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Between 1982 and 1993 we performed internal fixation or resection in 95 adult patients for radial head fracture. It was possible to follow up 68 patients for an average of 2.1 years. In 53 cases the initial injury was an isolated radial head fracture, which was treated by internal fixation in 41 and resection in 12 cases. ⋯ A satisfactory outcome was associated with young age, little initial fragment dislocation, internal fixation with screw + K-wire, and early postoperative physiotherapy. Primary resection for crush fractures of the radial head did not have negative long-term effects. In a comparison group with complex elbow injuries (elbow luxation in 9 and a Monteggia-type injury in 6 cases) in addition, results were considerably poorer and did not depend on the above-mentioned factors.
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Nailing technique has changed in recent years in some important aspects which are not limited to the omitted reaming procedure. These changes concern patient positioning, reduction technique, the use of temporary stabilizers such as the 'Pinless', and determination of implant length and diameter. Approach and exposure techniques have been modified to new, less invasive procedures, in order to fulfill technical, functional and aesthetic requirements. ⋯ Mean time to union was 23.9 weeks (range 10-48 weeks, n = 73); in two cases non-union was observed. The overall result was judged with the Karlström-Olerud score, which was applicable in 66 of 75 cases; excellent, n = 2; good, n = 22; satisfactory, n = 24; fair, n = 9; poor, n = 9. In the remaining nine cases no scoring was attempted because of severe injuries around the knee or ankle.
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Various different interlocking intramedullary nail designs are now available for the tibia the designs resulting from a different approaches to achieving stability for fracture fixation. During recent years small-diameter unreamed interlocking nails have been developed. So far there are no data on stiffness of different nail designs that can justify the use of certain nail types. ⋯ Four-point bending was done up to a moment of 66 Nm. For each implant bending and torque stiffness of the nail were calculated and compared with the test results obtained in the cadaver study. A P-value less than 0.05 (least significance difference test, ANOVA) was considered significant.(ABSTRACT TRUNCATED AT 250 WORDS)
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Fractures of the ankle in adults are very common. Like every intraarticular fracture, they require perfect reduction and stable fixation to guarantee a good result. In most cases this can only be achieved by open treatment. ⋯ From 1978 to 1992 more than 1000 ankle fractures were treated in our clinic by open reduction and fixation: 72 were type C ankle fractures, and the rest, either type A or type B fractures. When we reviewed our type C fractures we found 9 patients with so-called atypical type C fractures; these have an atypical fracture pattern insofar as a fracture of the medial malleolus is combined with tibiofibular ligament lesion and there is no fibula fracture. Definition, diagnosis, treatment and results are presented in this publication.