Der Unfallchirurg
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Review Case Reports
[Bent titanium elastic nail in clavicular non-union : Case report and review of the literature.]
Fractures of the clavicle can often be treated conservatively. For severely dislocated but simple fractures in which conservative treatment often fails, intramedullary nailing with titanium elastic nails (TEN) shows similar results to stable plate osteosynthesis. We present the case of a 28-year-old female patient who had been treated with TEN osteosynthesis 4 years previously but clavicular non-union developed. ⋯ We were able to remove the wire and stable plate osteosynthesis was carried out. Bending and migration of titanium wires used in clavicular fractures are relatively rare complications and patients must be informed accordingly. These complications can be avoided by removal of the wire 3-12 months after implantation when the fracture has healed.
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Osteochondral fractures are traumatic shearing injuries to the cartilage and the subchondral bone which lead to defects in the articular surface and potentially lead to further degeneration and arthritis. Early diagnosis and therapy are therefore very important. As the resolving power of conventional X-rays is limited for this situation, magnetic resonance imaging (MRI) is regarded as the gold standard for diagnostics. ⋯ Concerning treatment options for osteochondral fractures, there are two potential strategies that can be applied: the first is removal of small osteochondral fragments with subsequent formation of regeneration tissue and the second is refixation of the dislocated fragment and therefore a 1-stage reconstruction of the joint surface. It is important to also address concomitant injuries. Even though there is no consensus for a standardized or evidence-based therapy in literature, this article gives an overview of the diagnostics and available therapeutic options.
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According to the future demographic trends the incidence of proximal humeral fractures and subsequent posttraumatic malunions and nonunions of the proximal humerus are expected to substantially increase. ⋯ A variety of corrective surgical strategies are available, which are indicated depending on the location and extent of the malunion. The depicted single-cut osteotomy technique represents an elegant therapeutic option for multidimensional deformities of the proximal humerus. Nonunions of the proximal humerus can usually be successfully managed with autologous cancellous bone grafting and locking plate osteosynthesis.
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Arthroplasty of symptomatic sequelae after fractures of the proximal humerus is a demanding procedure for surgeons. Exact preoperative planning is crucial in order to achieve acceptable functional results. ⋯ Each case needs a thorough and individualized preoperative assessment along with exact planning and should therefore be reserved for experienced shoulder surgeons only.
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The management of glenohumeral osteoarthritis in younger patients with high activity levels remains a challenge to orthopedic surgeons. The clinical results of joint replacement surgery are commonly unsatisfactory in this particular cohort with the associated problem of limited longevity of the implant. ⋯ Arthroscopic procedures are a good option to treat young, active patients with osteoarthritis of the shoulder. Patient selection and setting a consensus for appropriate preoperative expectations are of particular relevance.