Der Unfallchirurg
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Non-operative treatment with immobilization or isometric traction has been abandoned as treatment for fractures of the distal femur at the end of the 1960ies. The technique of open reduction and internal fixation with a condylar plate as suggested by the AO has been the golden standard since the 1970ies. However, anatomic reconstruction of the condylar region with interfragmentary screw fixation and axial realignment of the femur shaft with a plate are challenging procedures especially in the presence of severely compromised soft tissues and put periosteal blood supply at risk. ⋯ The era of retrograde femoral nailing began with the systematic approach through the intercondylar notch by Green. This paper reviews the biomechanical properties, indication, technique as well as potential hazards and pitfalls of fracture management with the AO "distal femoral nail" (DFN). With appropriate application this technique is suitable for all fractures of the distal third of the femoral shaft including highly instable bicondylar fractures without damage to the soft tissues and the knee joint.
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Comparative Study Clinical Trial
[Heparin-induced thrombocytopenia as a complication of postoperative prevention of thromboembolism with unfractionated heparin/low molecular weight heparin after hip and knee prosthesis implantation].
With this prospective study we analysed the occurrence of a heparin-induced thrombocytopenia type II (hit type II) using unfractioned heparin (UFH) or low-molecular-weight heparin (LMWH) as postoperative thrombosis prophylaxis after primary total hip or knee replacements. Furthermore the postoperative course of the platelet count with UFH and LMWH was investigated. ⋯ The incidence of a HIT type II after the use LMWH seems to be lesser than after the use of UFH. The postoperative platelet count shows a typical course after a total joint replacement. With deviations of that a HIT type II must be excluded.
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Comparative Study Clinical Trial
[Primary external fixation with consecutive procedural modification in polytrauma].
It is the purpose of the current investigation to determine whether immediate external fixation of fractures, which is a simple and fast procedure, followed by secondary planned conversion represents a safe and reliable procedure without additional trauma in multiply injured patients (ISS > 15). ⋯ Immediate external fixation in multiply injured patients is fast and poor of complications. It is a expedient procedure which is safe and careful for critically ill patients. The required conversion procedure shows no raised rate of complications.
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Computer assisted navigation-based surgery is a novel and interesting challenge for todays surgeons. One must however keep in mind, that the indications for these techniques (a) should be carefully considered, (b) used only if morbidity is not increased and (c) when previously problematic or inacurate surgical methods can be improved upon. ⋯ Percutaneous retrograde drilling (cf. [6, 7, 9, 15, 20, 21]) spared the joint's cartilage in all cases. At the level of the knee joint we see the usefulness of this method for complex situations (cf. [12, 13]) requiring precise drilling.