Unfallchirurgie
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Case Reports
[Humeral head fractures following epileptic attacks. Case report on a rare but typical injury].
We report about two patients with posterior fracture-dislocation of the shoulder following convulsive seizures, one case unilateral, one case bilateral. The radiological findings are typical and similar to the cases described in literature: Impression or head splitting fracture of the ventro-medial part of the humeral head associated with posterior dislocation. The mechanism of injury, methods of treatment and late results are discussed.
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In this paper late results of 65 proximal humeral fractures, operated upon between 1970 and 1980 are reported. Fractures were classified according to Neer in two-part-(28), three-part-(15), four-part-fractures (21) and fractures of the articular surface (1). In 34 cases internal fixation was performed by a T-plate. ⋯ Avascular necrosis of the humeral head was encountered in 4 cases of four-part-fractures and fracture dislocations, 3 of them fixed by T-plate and 1 by minimal internal fixation. No case of avascular necrosis of the humeral head was encountered in two- or three-part-fractures, fixed by T-plate. We can conclude, that cases, having a high risk for developing avascular necrosis of the humeral head, i.e. four-part-fractures and fracture dislocations, are better treated with minimal internal fixation avoiding the use of T-plate, for it was found to increase the already present damage.
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The good prognosis of proximal humeral fractures in children and adolescents is explained by the anatomy of the shoulder and the physiology of the proximal humeral epiphysis. The treatment of these injuries therefore is mainly conservative. Based on the results of 24 patients operated between 1970 and 1980 a therapeutic concept concerning indication, timing and operative technique is proposed.
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Ruptures of the quadriceps and patellar tendon are comparatively rare lesions. From the number of cases from 1973 till 1983 17 ruptures of the femoral extensor tendon and 8 ruptures of the patellar tendon were controlled diagnostically, therapeutically and in view of their long-term results. Causally in the group of quadriceps tendons 13 spontaneous ruptures were facing 4 traumatically caused ruptures. ⋯ In each individual case the aspects of expert opinion were traced - above all in case of tendon ruptures with osseous patella lesions. For the first time a temporally staggered bilateral spontaneous rupture of the patella was described. The operative approach has been discussed just as much as the necessity to examine the internal knee-joint structures arthroscopically in case of the plurality of accompanying retinaculum lesions.
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In accident diagnosis, the computed tomogram (CT) is nowadays decisive for the determination of craniocerebral traumas. This is true for children as well as for adult patients. ⋯ Furthermore the injuries to the osseous skull which can be represented by CT and the late consequences of the accident are mentioned. The special aspects of craniocerebral traumas in children are taken into consideration.