Zentralblatt für Chirurgie
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Patients with bony defects of the proximal femur after trochanteric fracture, implant failure (cut-out), periprosthetic fracture or aseptic loosening of prosthesis are difficult to treat with primary or revision endoprosthesis. Modular femoral hip prosthesis (MHP) with stems of different length and the possibility of distal interlocking screws are an operative solution for those patients. In a prospective study from January 1996 to January 2002 all patients treated with a MHP because of proximal and / or distal femoral bony defect or fracture were included. ⋯ However in patients after revision arthroplasty 25 % of MHP were loose and in many patients the interlocking screw was broken. Distal interlocking screw in MHP prevents stability after trochanteric fracture to achieve osseointegration. However in case of periprosthetic fracture or revision arthroplasty MHP shows insufficient stability in many cases.
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Chest wall instabilities after extensive injuries of its skeleton belong to the most serious chest trauma with a relatively high rate of complications and mortality, mainly due to its pathophysiological consequences for the respiratory system. ⋯ Our experience with metallic fixation of the unstable chest wall is mainly positive. Decisive for the success of this procedure is the correct indication respectively selection of patients that will have a benefit from the surgical stabilisation.