Aktuelle Traumatologie
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Aktuelle Traumatologie · Jul 1993
Comparative Study[Change in the procedure from external fixator to intramedullary nailing osteosynthesis of the femur and tibia].
Shaft fractures of femur and tibia can be treated successfully by intramedullary nailing. In recent years the use of interlocking nails widened the indication for nailing fractures of the proximal and distal bone and more difficult fractures. There are still limits in polytrauma patients, chain fractures with or without participation of joints and in fractures with severe soft tissue injury (open or closed). ⋯ The difference between contamination and infection rate can be explained by experience in the technique of nailing, considering biological aspects (no or little reaming), the standardized change of method and the prophylactic use of antibiotics. In a follow-up of additional 37 femur and 58 tibia fractures that were treated accordingly, a total infection rate of 1.9% was achieved (2% in femur fractures [n = 98], 1.8% in tibia fractures [n = 164], 1.9% total [n = 262]). In femur and tibia fractures with open or closed soft tissue damage and in multiple trauma patients the treatment with initial stabilisation by external fixation and secondary change to intramedullary nailing can be recommended under certain conditions.
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Patients with pelvic trauma often have other multiple injuries that cause special problems. Therefore a quick and thorough diagnosis as well as therapeutic management according to the special situation and findings is necessary. Effective cooperation of all the different specialists concerned with the treatment of the patient is mandatory. ⋯ In cases of instability external fixation of the pelvis is usually performed first. Change over to internal stabilisation and osteosynthesis should be tried as soon as possible. The different procedures for treatment are associated with specific risks and complications.
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Aktuelle Traumatologie · Jul 1993
[Results of treatment of 475 second- and third-degree open fractures of long tubular bones (1974-1988)].
Open fractures with severe soft tissue damage are undergoing a change in therapeutic management. The impairment of vascularisation concerning bone and surrounding tissue has been gaining increasing importance. In addition to the primary stabilisation of 2 degrees and 3 degrees open fractures of long bones by external fixation including open wound treatment with artificial skin substitutes, local or free muscle flaps became an essential part of therapy. ⋯ From 1974 to 1988 a total of 475 2 degrees and 3 degrees open fractures of long bones were initially treated at the BGU Tübingen. The follow-up of three groups of patients shows the development in therapeutic management of these severe injuries. In spite of a considerable rate of postoperative infections most cases show satisfactory functional results within an acceptable period of time (infection rate between 11.4 and 22.2%, average bone healing between 26 and 30 weeks).
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Aktuelle Traumatologie · Jul 1993
Comparative Study[Results of treatment of humerus shaft fractures].
"It is common practice to treat shaft fractures of the humerus conservatively" says the relevant literature. The results of 126 humerus shaft fractures in the years 1980 to 1989 are reported: 28 fractures were treated conservatively, 98 fractures underwent surgery using plate fixation, mainly the broad AO/ASIF-4,5-mm-DCP. ⋯ The striking advantages of internal fixation are the chance of early functional treatment and the high convenience for the patient. The results reveal correctly performed osteosynthesis as an alternative method to conservative treatment of humerus shaft fractures.
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Aktuelle Traumatologie · Jun 1993
Review[Traumatology of the finger nail. Systematic aspects--therapeutic concepts--review of the literature].
The anatomy of the fingernail and its significance for tactile diagnosis is shown. Injuries are described and arranged in a system. On the base of this system guidelines are worked out to create a uniform therapy as far as possible. Immediate action is the best way to treat finger nail injuries.