Der Unfallchirurg
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Neuro-osteoarthropathy is accompanied by the destruction of single or multiple joints involving little or no pain. Diabetic patients suffering from symmetric distal polyneuropathy are the main risk group. The main location is the foot (Charcot foot). ⋯ Surgery is an essential part of treatment and should be integrated into the overall treatment plan. The main indications for orthopedic reconstruction are non-plantigrade foot and ankle deformities or instabilities with concomitant ulcers that cannot be adequately addressed by non-operative measures, mainly in the chronic stage of Charcot foot. As such, surgical reconstruction can contribute to the long-term preservation of the affected foot and help to maintain or improve the patient's mobility and quality of life.
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The incidence of gunshot wounds is increasing also in Europe and surgeons in urban trauma centers are more frequently confronted with this type of injury. Since there is no established treatment algorithm for gunshot injuries to the extremities, the surgeon should rely on established soft tissue injury and fracture protocols. Gunshot fractures with minor soft tissue destruction should be treated as closed fractures. ⋯ Prophylactic intravenous antibiotics are mandatory and prophylactic fasciotomy is often required. Upon definitive internal stabilization, bone grafting should be considered since gunshot fractures are usually associated with a high degree of comminution. Articular gunshot injuries are treated as open joint injuries and require irrigation, debridement, foreign body removal and antibiotic prophylaxis.