Der Unfallchirurg
-
Periprosthetic fractures in patients with underlying rheumatic diseases can be a special challenge depending on the extent, bone quality and septic complications. ⋯ The treatment of periprosthetic fractures with underlying rheumatic diseases necessitates the specific consideration of the multiple accompanying conditions. In general, extra-articular manifestations, average younger age, increased susceptibility to infections, multiple joint involvement and the basic medication must be taken into consideration. The local poorer bone quality can require an adaptation of the surgical technique. These factors are summarized in a treatment algorithm for periprosthetic fractures in patients with rheumatism taking the stability of the prosthesis, the infection status, the etiology, the localization and extent of the fracture into consideration.
-
Since the introduction of biologicals and small molecules for the treatment of inflammatory rheumatic diseases, these patients are more active and therefore sustain more accidents. The hands and feet are most affected by inflammatory rheumatic diseases, especially rheumatoid arthritis, and are also very exposed to injuries. Therefore, rheumatoid patients have a high coincidence of injuries and rheumatic destruction of the hands and feet. ⋯ This is necessary to avoid fundamental errors in the treatment of fractures and optimally used anesthesia for the benefit of the patient. The close cooperation between trauma surgeons and orthopedic rheumatologists is urgently recommended in the treatment of these injuries. Whenever possible, the treatment should be carried out conservatively because surgical treatment has a higher risk compared to the normal population due to the immunosuppressive treatment.
-
Inflammatory rheumatic diseases in childhood and adolescence are a special challenge in the treatment of acute trauma. The pharmaceutical treatment strategies for children and adolescents have been modified. ⋯ An interdisciplinary concept can help to avoid disadvantages in the treatment of the underlying disease. Due to the special dysplastic anatomy and tissue alterations, trauma in these patients is a particular challenge.
-
This article reports a case of medial dislocation of the talus as a rare injury caused by a fall from a low height. Treatment recommendations given in the literature for this rare injury are heterogeneous but closed reduction is predominant. ⋯ The known complications include posttraumatic arthritis and necrosis of the talus. A posttraumatic lesion of the tibial nerve has not been reported, which is why a treatment recommendation is illustrated and discussed based on this case report.
-
There is no standard procedure regarding surgical treatment of multiligament knee injuries involving rupture of the posterior cruciate ligament. ⋯ The results of the two operation techniques were not significantly different. The arthroscopic approach is therefore regarded as the preferred method in this institute.