Der Unfallchirurg
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The indications for stabilization of the posterior malleolus (Volkmann triangle) while fixing ankle fractures are controversially discussed. Detailed descriptions of possible obstacles to reduction are scarce. ⋯ The fracture line of the posterior malleolus passed in an atypical manner vertically to the posterior-medial tibial margin with direct contact to the anatomical pathway of the tendon. The impaction of the tendon was already present in the computed tomography (CT) scan taken preoperatively but the tendon hindering malleolar reduction was first realized during surgery after several unsuccessful attempts at repositioning.
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In the late 1960s, helicopter emergency medical services (HEMS) were established because of the increasing number of severely injured in road traffic accidents. It was initially thought to bring the doctor to the patient quickly. ⋯ The results showed that around 30 % of severely injured are allocated to hospitals by HEMS. In addition to regional differences, the level of the hospital also plays a particularly important role. The combination of the transfer by HEMS and treatment in a level I trauma center has a significantly positive effect on the survival rate of the patient, especially in patients with traumatic brain injury (TBI).
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The incidence of femoral neck fractures increases exponentially with rising age. Young patients are rarely affected but when they are it is mostly due to high energy accidents, whereas older patients suffer from femoral neck fractures by low energy trauma due to osteoporotic changes of the bone mineral density. Treatment options have not essentially changed over the last few years. ⋯ Osteosynthetic fracture stabilization with cannulated screws or angle stable sliding screws, is usually applied in non-displaced fractures and fractures in younger patients. Older patients need rapid mobilization after surgery; therefore, total hip arthroplasty and hemiarthroplasty are commonly used with a low incidence of secondary complications. In addition to sufficient operative treatment a guideline conform osteoprosis therapy should be initiated for the prophylaxis of further fractures and patients should undertake a suitable rehabilitation.
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Randomized Controlled Trial Comparative Study
[Detection of intrinsic ligament and TFCC lesions of the wrist : Direct versus indirect MRI arthrography.]
The purpose of this study was to validate the diagnostic value of direct magnetic resonance imaging (dMRI) arthrography and indirect MRI (iMRI) arthrography concerning intrinsic ligament injuries and tears of the triangular fibrocartilage complex (TFCC). ⋯ Indirect MRI arthrography is a suitable method for detection of injuries of the TFCC and intrinsic ligaments of the wrist with good sensitivity and specificity. Despite the low number of patients the results of this study showed that there were no essential differences between dMRI and iMRI arthrography with respect to the diagnostic value for carpal injuries of the wrist.
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The bone marrow edema syndrome (BMES) is a painful joint disease which usually affects healthy middle aged persons. It is usually treated conservatively. ⋯ Complete restitution of the bone marrow edema in the knee and the disappearance of clinical complaints were observed 8 weeks after a single therapy with 60 mg denosumab (Prolia®) as a subcutaneous injection. No side-effects of the therapy were noted.