Der Unfallchirurg
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Fractures of the anteroinferior glenoid rim, termed bony Bankart lesions, have been reported to occur in up to 22% of first time anterior shoulder dislocations. The primary goal of treatment is to create a stable glenohumeral joint and a good shoulder function. Options for therapeutic intervention are largely dependent on the chronicity of the lesion, the activity level of the patient and postreduction fracture characteristics, such as the size, location and number of fracture fragments. ⋯ On the other hand chronic fractures are generally managed on a case-by-case basis depending on the amount of fragment resorption and bony erosion of the anterior glenoid with high recurrence rates under conservative therapy. When significant bone loss of the anterior glenoid is present, anatomical (e.g. iliac crest bone graft and osteoarticular allograft) or non-anatomical (e.g. Latarjet and Bristow) reconstruction of the anterior glenoid is often indicated.
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Posterior dislocations of the shoulder represent a rare injury with frequently occurring soft tissue and/or bony concomitant lesions such as the reverse Hill-Sachs lesion and the dorsal labrum tear. For the combination of these injuries, no evidence-based therapeutic recommendations exist. ⋯ These cases show that for the operative treatment of fresh, traumatic posterior shoulder dislocation, it is useful to explore the joint arthroscopically to identify concomitant injuries of the labrum and if necessary treat them. The bony pathology of the humeral head can subsequently be addressed in an open technique, whereby the appropriate treatment should be chosen based on the size of the defect.
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The treatment of femoral shaft fractures has increasingly become a domain of surgical therapy. On the one hand the possibilities of spontaneous correction of shaft axis deviation and rotation are limited and on the other hand leg length differences are often observed as a result of shaft fractures, which can lead to relevant consequences for spinal and pelvic statics. ⋯ Newly developed implants currently provide a variety of methods for osteosynthesis for each age group and each fracture type. This allows a better fracture, weight and age adjusted retention of fractures with increased stability and a lower risk of post-traumatic leg length differences. Secondary effects are prompt mobilization and reintegration in the social environment of patients and hence a better achievement of their own therapeutic goals.
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Case Reports
[Epilepsy and transverse sternum fractures : Sternum fractures in drug-induced osteopenia.]
Fractures of the sternum are a very rare injury. The combination of indirect trauma and transverse fracture in case of an epileptic seizure has been described only in one case. ⋯ In the current literature, there are no clear recommendations for the treatment of such fractures. Plate osteosynthesis, as an alternative to conservative treatment of such fractures, is presented and discussed.
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The distal forearm fracture is the most common injury (40%) in pediatric traumatology. ⋯ Treatment of distal forearm fractures should be appropriate for children as well as highly efficient, by using a minimal amount of effort. Current forms of overtreatment have to be avoided because of moral and in particular economic reasons.