Der Unfallchirurg
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Insertion of titanium nails for type A and B clavicular fractures can fail intraoperatively due to the small diameter or irregular nature of the medullary canal. At present, such failures lead to open reduction and fixation (ORIF) with plates. In type C fractures (comminuted fractures), a telescoping effect is observed so that ORIF is the only suitable alternative besides nonoperative therapy. A suitable minimally invasive solution for type C fractures and as a salvage procedure for failed intramedullary nailing of type A and B fractures is presented here for the first time with a percutaneous application of an LC plate to the clavicle.
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Clinical Trial
[Closure of defects on the dorsum of the foot with free flaps. Functional and aesthetic aspects].
Large complex soft-tissue defects on the dorsum of the foot, with exposed tendons, joints, bones, nerves and vessels, have to be reconstructed by transplantation of free tissue grafts with good blood flow. ⋯ Free muscle flaps with skin grafts, particularly the free gracilis muscle flap, are superior to fasciocutaneous flaps and perforating flaps in aesthetic outcome and donor site morbidity.
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Clavicle fractures are the most common break injuries in humans second to radius fractures. They often occur alone, mostly after falling directly onto the shoulder and less often onto the stretched out arm. They are also not uncommon in connection with high speed trauma or multiple injuries. ⋯ Because the clavicle is necessary for precise, powerful and variable use of the arm, an exact morphological repositioning is extremely important. Approximately 90% of all clavicle fractures heal with good results after conservative treatment. However, in particular situations there are absolute (obligatory surgery due to vessel damage) or relative operation indications.
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Minimally invasive sacroiliac (SI) screw fixation carries a high risk for implant malposition. Only idealised shape conceptions of the safe bony corridor exist. ⋯ The computed realistic 3D models provide exact references to confining bone structures for safe screw positions. The implementation of a software algorithm for fully automated calculation of such volumes based on fluoroscopic or CT images could enhance the performance of computer-assisted navigation systems.
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While the number of fatal accidents decreases every year, there is still need for improvement and action to prevent these deaths. The basis for this purpose has to be an analysis about the factors influencing the car crash mortality. ⋯ Univariate assessments may be falsified by bias; this effect can be uncovered by multivariate models.