Der Unfallchirurg
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Traumatic physeal separations (SH I/II) of the lower extremities are rare. Complications are reported in 2.2-39.6%. The current study is intended to provide recent data concerning epidemiology and treatment decisions in physeal separation of the distal tibia. ⋯ The investigation confirmed epidemiological data of former studies. For the first time data concerning the treatment reality of physeal separations of the distal tibia were recorded. They consistently follow the recommendations of the appropriate literature.
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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.
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Within the framework of restructuring for the certification to a regional trauma centre of the DGU (German Society for Casualty Surgery), a uniform algorithm for multiple trauma was developed in the medical centre of Wolfsburg. The Wolfsburg multiple trauma algorithm is based on ATLS (advanced trauma life support) with integration of FAST (focused assessment with sonography for trauma), as well as the white paper of the DGU and regional-specific features. Thus structural, instrumental, organizational and personnel conditions were created to improve the care of multiply traumatized patients even further. The conditions for transition to a regional trauma centre of the DGU were confirmed by a successful audit.
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Dislocation of the patella represents a frequent knee problem in childhood and adolescence. There are traumatic, recurrent, habitual and chronic forms. Many anatomical variations, which promote patellar dislocation, are known. ⋯ Recurrent, habitual and chronic dislocations are best cured surgically by vastus medialis advancement, reconstruction of the medial patellofemoral ligament, strengthening of the medial retinaculum together with a lateral release and by fixation of the patella using tendon grafts or medialisation of the insertion of the patellar ligament. To improve the femoropatellar groove by trochleoplasty is a different surgical concept. The long-term results following medialisation of the patellar ligament insertion or trochleoplasty are good with regards to patellar stability but mediocre in terms of avoiding degenerative changes in the patellofemoral joint.
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Comparative Study
[Comparison of regional distribution of cancellous bone in osteoporotic and non-osteoporotic distal radii].
In cases of distal radius fractures information about the regional distribution of cancellous bone is essential for adequate fixation of osteosynthesis material. ⋯ In osteoporotic distal radii cancellous bone density decrease occurs homogeneously in all regions and is least pronounced beneath the joint surface. Comparing the regional cancellous bone density (radial versus ulnar and palmar versus dorsal) significant differences were mainly found near the joint surface in both groups.