Der Unfallchirurg
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Dislocation of the elbow joint is the second most common dislocation, the shoulder being the most common. Non-surgical therapy is done by repositioning and early active motion after a short period of immobilization. There are, however, certain principles which must be followed in order to obtain a favorable result with functional therapy. ⋯ Knowing the mechanism or kinematics of an elbow dislocation, it is possible to determine a staging of the injury. Using detailed x-rays and an exact stability test, the degree of instability must be checked after repositioning. It is important to determine the grade of instability and to operatively correct a major instability.
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Over the last years, many special instruments and implants were designed for operative treatment of fractures of the wrist and hand. Therefore, conservative treatment of these injuries became old-fashioned in the eyes of most patients and surgeons. ⋯ The key to success is thorough knowledge of the use of casts, splints, and functional therapy and good patient compliance to avoid complications. Opportunities for conservative treatment of fractures of the wrist and hand are herein described.
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Functional bracing of humeral diaphyseal fractures was conceived after initial experiences with a similar method was used in the management of diaphyseal tibial fractures. Over the years, tibial functional bracing underwent major evolutionary changes, and found its indications basically limited to a smaller group of fractures, consisting of closed, axially unstable fractures that experience at the time of the injury an acceptable degree of shortening, and to transverse fracture that are appropriately reduced and rendered stable. ⋯ In 97.5% of the patients, the average healing time was 11.5 weeks. 16 patients (2.5%) required operative intervention because of a nonunion and 4 patients (<1 degrees) of the patient had a refracture after brace removal. Nerve function did not return in only one of the 67 patient who had radial nerve palsy.
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Fractures in children require special knowledge and skills due to the differences in biological and biomechanical properties of growing skeletons. Children suffer from fractures of the upper extremities much more than fractures of the lower extremities. ⋯ In order to correctly decide about treatment regimes (conservative versus operative treatment) the limitations and limits of the ability of bone to correct misalignment must be anticipated. Clinical examination following fracture healing is mandatory to recognize differences in length, misalignment and deficits in function, which should receive further treatment.