Der Unfallchirurg
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The exact incidence of postoperative periprosthetic humeral fractures (PPHF) months or years after fracture-related implantation of a hemiprosthesis is unknown. The currently available literature is predominantly concerned with operative treatment approaches. As a rule, these involved older patients and severe fracture conditions so that severe complications and unsatisfactory healing results were described. This article presents an alternative conservative treatment approach which is discussed based on the results of treatment. ⋯ The conservative treatment of PPHF can be a safe treatment option in multimorbid and chronically ill patients. A close outpatient control and good patient compliance are important. In incompliant and dementia patients, the risk of failure of conservative treatment is increased.
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Ankle fractures and associated ligamentous injuries are the most common injuries of a load-bearing joint. There is still no general consensus with respect to the pathomechanism, the treatment indications and surgical techniques. ⋯ This detects relevant pathologies, such as bony syndesmotic avulsion and partial impaction of the tibial plafond that may go unnoticed on plain radiographs. Anatomic reconstruction of the ankle mortise, the detection and treatment of syndesmotic instability, reconstruction of the tibial notch and exact placement of the distal fibula into the latter are important prognostic factors.
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The diagnostics and treatment of pediatric skeletal trauma can be fundamentally different from adults. Based on in-house data the diagnostic approach to the most frequently encountered pediatric injury patterns is discussed. ⋯ Both diagnostic methods cause stochastic radiation damage. Therefore, it is important to perform the safest examination for the child while injuries are correctly diagnosed.