Der Unfallchirurg
-
The basis for the classification of acetabular fractures depends on accurate radiological diagnostics. The use of conventional X-rays alone implicates a low intrapersonal reproducibility and interpersonal reliability. By applying computed tomography (CT) at an early stage in the emergency room, the typical diagonal X-rays of ala and obturator, on which the classification is based, are no longer recommended. The aim of this study was to develop a new reliable classification system based on standardized CT slices according to the system of Judet and Letournel without using diagonal X-rays. ⋯ The CT-based classification developed represents an adaption to the current standard of diagnostics of acetabular fractures and represents a step towards simplification of the classification. It is suitable to estimate the correct surgical approach and the behavior of the fracture. For an accurate classification and the association to one of the fracture types in the system of Judet and Letournel more slices and 3D reconstructions (MPR) are necessary.
-
Spinal and pelvic surgery (as in neuromuscular scoliosis or unilateral highly unstable vertical sacral fractures or unstable H- or U-shaped sacral fractures) relies on lumbopelvic fixation. This technique belongs to the standard procedures for lumbosacral injuries in orthopedic surgery. Preoperatively, a CT scan with 1 mm slices is essential to detect anatomical variants and cortical narrow nesses. ⋯ The safest screw path was determined as the bony canal between the posterior superior iliac spine (PSIS) and the anterior inferior iliac spine (AIIS). Intraoperatively, standard fluoroscopic views allow safe placement of the screws. The aim of the following manuscript is to illustrate anatomical and morphological aspects of the spine and pelvis as well as to describe important bony landmarks and optimal intraoperative C-arm views for optimal screw insertion.
-
Multiplanar posterior pelvic ring instabilities are severe injuries and typically occur in the os ilium, the sacroiliac joint, the sacrum and/or in a combination of these sites. They pose challenges to the orthopedic trauma surgeon during reconstruction, particularly when these injuries are associated with multiplanar sacral fractures and involvement of the lumbosacral junction. Due to the multidirectional forces affecting the pelvic ring, one has to have basic knowledge about the mechanism of injury, its biomechanics, and the various treatment options. In the following we give an overview on injury classifications, biomechanical aspects of the injuries and various types of operative treatments and osteosynthesis techniques.
-
Hyperpneumatization of the craniocervical bones is a very rare disorder and there are only assumptions as to the cause of this potentially dangerous condition. This article reports the case of a 44-year-old patient with severe pneumatization who became symptomatic after a minor skiing accident without any direct trauma.
-
Case Reports
[Pediatric calcaneal fracture after supination trauma : Conservative therapy with an orthosis.]
We report the case of a 12-year-old boy with a calcaneal fracture due to a simple supination trauma. As magnetic resonance imaging (MRI) showed a non-displaced extra-articular fracture no surgical treatment was necessary. A conservative therapy using calcaneal fracture orthosis with full weight bearing was carried out. Using this procedure allowed a comfortable means of movement without the need for a plaster cast immobilization or forearm crutches accompanied by a rapid return of the child to the normal daily routine.