Der Unfallchirurg
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We report the case of a 69-year-old female patient who sustained a traumatic anterior dislocation of the tibialis posterior muscle tendon. A computed tomography (CT) scan demonstrated an osseous avulsion of the flexor retinaculum with the tendon dislocated underneath it. The patient underwent surgical exploration with reduction of the tendon to its anatomical position and screw fixation of the avulsed fragment. The postoperative course showed pain-free mobility and no signs of tibial posterior muscle tendon insufficiency.
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Peripheral nerve injuries are often encountered in traumatological care. The aim of this manuscript is to provide initial data, experiences and performance reports from Germany in the implantation of acellular human nerve transplants in peripheral sensory nerve defects of the hand and to put these data in the context of a comprehensive review of the literature. ⋯ All patients had a clinical improvement after nerve reconstruction (≥ S3 according to the classification of sensory recovery of the Medical Research Council modified by Mackinnon and Dellon). Disadvantages of our clinical study are the small number of patients, the inhomogeneity (primary and secondary nerve reconstruction) and the lack of comparison with other nerve reconstruction methods.
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Nonunions after median sternotomy are rare and usually respond well to surgical treatment. Recalcitrant nonunions despite surgical treatment require a comprehensive mechanical and biological treatment strategy to achieve an adequate functional result for the patient. ⋯ Through a surgical approach guided by the criteria of the nonunion scoring system (NUSS) successful healing was achieved. Our strategy as well as the treatment course are presented.
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The v. Bodelschwingh Foundation Bethel can look back on a tradition of more than 150 years in the treatment of people with disabilities. The trauma patient collective is regularly characterized by the most severe mental and physical developmental disorders and (multiple) disabilities, with and without behavioral disorders and concomitant internal diseases. ⋯ Due to a high postoperative complication rate, conservative treatment plays a crucial role. The decision for surgical treatment must be made on an interdisciplinary and individual basis, taking all factors into account. Special attention must be paid to the procedure to be chosen (stability, functional needs).