Der Unfallchirurg
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Acute or chronic instability and osteoarthritis of the acromioclavicular (ac) joint may cause significant impairment of the shoulder. In this continuing education report, the pathomorphology of acute ac dislocations is described based on the Rockwood classification. Decision making on conservative or surgical treatment is discussed. ⋯ A modified Weaver-Dunn procedure is presented in detail. In any patient with shoulder pain, osteoarthritis of the ac joint has to be taken into consideration. Resection of the lateral clavicle has proved to be effective in these patients.
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Review Case Reports
[Treatment of traumatic rotatory atlanto-axial subluxation in childhood. Case report and literature review].
Cervical spine injuries are rare in children. They tend to occur predominantly in the region of atlanto-axial articulation. Even traumatic rotatory atlanto-axial subluxation (AAD) has been described in the literature, however, there is no consistent therapeutic protocol. ⋯ As there is a correlation between outcome and increasing length of the dislocation-therapy interval, optimal management of acute rotatory atlanto-axial subluxation depends on early diagnosis with plain radiography and CT scans. Timely diagnosed cases may be treated successfully with closed reduction and cervical immobilisation in a hard-collar. Failure to obtain reduction and recurrence are an appropriate indication for surgical intervention.
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Optimal timing of operative treatment of upper extremity long bone fractures in polytraumatized patients depends on the type and location of the fractures, as well as on the cardiorespiratory stability of the patient, and should be early in diaphyseal fractures in order to optimize intensive care treatment. The timing of surgery in cases of upper limb fractures is secondary to life-saving therapies. The same applies to stabilization of fractures of the lower limbs, including fractures of the femur and tibial shaft. ⋯ Amputations at the upper extremity in polytraumatized patients are only occasionally indicated in very severe injuries. In injuries involving total amputation, depending on the condition of the limb, immediate reattachment should be attempted if the cardiorespiratory situation of the patient is stable.
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Review
[Operative strategies for hand injuries in multiple trauma. A systematic review of the literature].
Hand injuries are not life threatening but crucial in multiple trauma because of their long-term functional results. The goal of this systematic review was to derive recommendations for diagnostic and treatment procedures from a systematic review of the literature. ⋯ Hand injuries represent important lesions in multiple trauma. Due to the life-threatening situation they may be overlooked in the beginning of the treatment. Because of their long-term consequences for function and health-related quality of life, hand injuries require an early and accurate diagnosis and a differentiated treatment strategy.
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Lower extremity injuries make up a substantial proportion of the injuries in multiply injured patients. The aim of this systematic literature analysis was to give an overview of the levels of evidence for different management strategies in the first operative phase after long-bone injuries of the lower extremity in multiply injured patients to enable, in the presence of adequate evidence, the development of clinical management corridors or, if the evidence was found to be inadequate, to document the necessity for scientific proof. ⋯ Numerous comparative studies (EL 2) dealing with management strategies in the first operative phase after long-bone injuries of the lower extremity in multiply injured patients are available, but there are only a few randomized studies. Based on the available data, it is possible to develop a rational therapy for this patient population.