Der Unfallchirurg
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This case report describes the osteosynthetic treatment and postoperative course of a fracture of the capitulum humeri and a concomitant fracture of the head of the radius with a follow-up over 3 months. Simultaneous fractures of the capitulum humeri and the head of the radius are rare injuries of the elbow. Due to the complex anatomical relationships this type of fracture poses a big challenge for treating traumatologists.
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Dislocation of the patella is one of the most common knee injuries in childhood and adolescence. After detailed clinical and radiological clarification, conservative functional treatment with special orthotic devices is most commonly applied in patients with a primary dislocation without concomitant injuries; however, the redislocation rate after conservative treatment has been reported in the literature to be between 35% and 70%, depending on the risk factors present. ⋯ Many scientific contributions on the topic notably in the last two decades have increased the understanding of patellofemoral instability. The comprehensive knowledge of the causes for a persisting instability of the patella has made the treatment more efficient and precise but also more complex.
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Case Reports
[Isolated fracture of the coracoid process in a 14-year-old national water polo player : Case example].
Isolated fractures of the coracoid process during sporting activities are very rare. There are a few case studies and retrospective studies with low numbers of cases. ⋯ In cases with therapy refractory shoulder pain after trauma and unremarkable native X‑ray, extended 3D imaging by magnetic resonance imaging (MRI) or computed tomography (CT) should be done early. Conservative therapy of a non-dislocated fracture in this case showed a good outcome.
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While fractures around the knee are known to be rare, physicians have encountered a rise in the frequency due to the increased participation of children and adolescents in high-impact sports at a younger age. Even if the treatment of fractures in some cases resembles that in adults, the diagnostics and treatment in childhood and adolescence require a hígh level of experience in order avoid possible sequelae and to enable early recognition. Thorough diagnostics using clinical and imaging investigations as well as a precise weighing up of the treatment are essential to minimize differences in leg length and axial malpositioning of the leg. ⋯ Decisive is the degree of dislocation of the fracture. In operative treatment, the axis conform reduction and subsequent stress stable treatment are particularly decisive. Avulsion trauma, bony avulsions of the intercondylar eminence and patellar injuries are also treated conservatively with immobilization or surgically with the aid of various fixation techniques, depending on the degree of dislocation.
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Fractures in childhood can result in malalignment and/or leg shortening due to insufficient reduction, malunion or injury to the growth plate. ⋯ Precise analysis of the deformity and leg length discrepancy is necessary to select the best point in time and the right surgical procedure and hardware for correction.