Der Unfallchirurg
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Patients must be informed of the chances of success and risks well in advance of the intended treatment measure so that they can adequately maintain a freedom of choice and thus the right to self-determination by carefully considering the reasons for and against the recommended measure. Fixed deadlines for the time between information and consent cannot be set as a blanket measure. ⋯ If this period of deliberation is not granted and consent is requested immediately, the doctor must convince himself before the treatment measure is carried out that the consent given still corresponds to the patient's will. This request is not necessary if the patient has expressly waived a period of reflection after receiving appropriate clarification.
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The current boom in recreational sports leads to an increase in the number of long-distance runners. In addition to typical disease patterns (e.g. of the Achilles tendon) stress fractures are seen more and more frequently. ⋯ Atypical and protracted complaints therefore require a detailed medical history of the patient and should if in any doubt lead to radiological imaging. Once correctly diagnosed, rest from sports and sometimes semi-weightbearing or non-weightbearing is indicated to prevent the development of fracture non-union.
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The secondary reconstruction of flexor tendons is in most cases very demanding and tedious. The indications, selection of the correct surgical procedure, operative technique and further treatment have to be individually adjusted and are mostly very difficult. Due to the previous operations unpleasant surprises may occur intraoperatively, which must be recognized and treated by the surgeon. Nevertheless, a significant improvement of the function of the whole hand can be achieved for most patients, e.g. by a two-stage flexor tendon transplantation or other techniques described in this article.
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The ideal surgical and postoperative treatment for flexor tendon injuries, especially in zone 2, is still subject to continuous modifications and professional discussions. ⋯ A stable tendon repair with smooth gliding is the foundation for treatment after flexor tendon injuries. After intraoperative active digital extension-flexion testing of the sutured tendon an early active rehabilitation approach should follow. New splint designs in combination with primary stable tendon suture techniques have the potential to improve the postoperative outcome, presupposing a reliable cooperation of the patient.