Der Unfallchirurg
-
Femoral shaft fractures in children represent 1.5% of all fractures in childhood. Up to the age of 4 years, conservative treatment in a hip spica or short-term overhead traction is the therapy of choice. Femoral shaft fractures between the age of 5 and 16 years should be treated surgically. ⋯ Additional end caps can be used for unstable fractures and in length discrepancy. The external fixator and the locking plate are reserved for fractures with severe soft tissue injuries, vascular problems and some specific situations mentioned later on. By adhering to these standards good results can be achieved with a low complication rate.
-
Only 1-4% of all long bone fractures in children involve the proximal tibia. To evaluate these fractures appropriately, it is mandatory to differentiate between articular fractures and metaphyseal fractures. Articular fractures of the proximal physis are rare and include Salter Harris type III and IV injuries. ⋯ Small deformities in the sagittal plane can be compensated by spontaneous remodelling during further growth. Dislocated fractures should be reduced and stabilized by K-wires. The retention of bending fractures by a compression plate or external fixator for medial compression might be more beneficial.
-
While complex regional pain syndrome (CRPS) is a well-established entity in adults, its occurrence in children was doubted for a long time. However, in the last few years several case reports and some comparative studies have described CRPS in children and adolescents. In contrast to adults most of the involved children are female, suffering from CRPS after an initial event that is typically a minor trauma. ⋯ The treatment concept is comprised of intensive physical therapy, pain management and psychological therapy, physical therapy having the major impact. In spite of a sometimes long and variable clinical course the prognosis in most cases is excellent and usually results in complete functional restoration. Nevertheless, relapses are described in up to 30% and can involve other locations or present in a different fashion regarding clinical symptoms.
-
Review Meta Analysis
[Percutaneous screw osteosynthesis of femoral neck fractures in the elderly. Subtrochanteric fractures as severe complications].
Percutaneous osteosynthesis by cannulated screws is a well established method for the treatment of non-displaced femoral neck fractures, especially in elderly patients with comorbidities due to low operative invasiveness. Optimal screw placement is still under discussion. ⋯ We performed a review of the literature and a retrospective analysis of our patients treated by this form of osteosythesis from 01.04.2004 to 30.09.2009 searching for screw placement and the incidence of subtrochanteric femoral fractures. This complication was found in 2 of our 35 patients (5.7%) without adequate trauma, such as a stumble or fall having occurred.