Der Unfallchirurg
-
Due to the unique anatomy and pathophysiology involved, a compartment syndrome (CS) of the lower leg and foot is prone to develop sequelae that demand operative reconstruction. Moreover, the two regions are closely related. Although research into various pathophysiological areas is revealing specific complexities, aspects of the foot's compartmental anatomy remain controversial, perhaps because of methodological reasons. This may result in particular practices for diagnosing and treating CS in this region, which are discussed in this article.
-
Bone substitutes are used to supplement or substitute autogenous transplantation of cancellous bone. These materials should provide a scaffold structure and support bone healing alone or in combination with other substances. ⋯ Moreover, biomaterials can be stored, also ensuring ready availability. This educational article gives an overview of bone substitutes currently in clinical use.
-
Severe intraoperative bleeding may endanger the patient's life, necessitate additional human resources and increase perioperative costs. The aetiology of perioperative coagulopathy is complex and consists of depletion, consumption and dilution of clotting factors and thrombocytes. Cofactors like hypothermia, acidosis and severe anaemia may aggravate coagulopathy. ⋯ Evaluation of the clinical bleeding situation and coagulation tests, in particular point-of-care testing like thrombelastography, should be used to guide and control the therapeutic strategy. Fresh frozen plasma, concentrates of clotting factors, platelet concentrates and antifibrinolytic drugs are available for therapy of perioperative coagulopathy. To obtain optimal benefit for the patient, these products should be applied based on a therapeutic algorithm.
-
Heterotopic ossifications (HO) are defined as the abnormal formation of bone in soft tissues. It can be classified into acquired and congenital forms. The acquired form, of which the pathogenesis is not fully understood, is often diagnosed in patients with traumatic brain injury, spinal cord injury, musculo-skeletal trauma or injuries associated with burns. ⋯ Imaging techniques, foremost bone szintigraphy, are mostly used for verification of the diagnosis. Local radiotherapy and nonsteroidal anti-inflammatory drugs are the classical therapeutic and prophylactic options. In advanced stages, surgical resection may be required.