Der Unfallchirurg
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Review Comparative Study
[Periprosthetic fractures: classification, management, therapy].
The incidence of periprosthetic fractures is increasing because of the increasing age and the rising number of joint replacements. Elderly patients are endangered because of a higher rate of co-morbidity such as osteoporosis or cardiovascular diseases. The treatment of periprosthetic fractures depends on these preconditions and has to solve the problem after an exact analysis of the fracture. ⋯ Intraoperative and postoperative periprosthetic fractures will be discussed with emphasis on classification and treatment. The aim has to be an early functional postoperative treatment with partial/full weight bearing in order to avoid postoperative complications. In discussing the scope of periprosthetic fractures, the site, incidence, treatment and outcome of periprosthetic fractures of the hip and knee will be outlined.
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Review Comparative Study
[Endoprosthetic replacement of the ankle joint].
Endoprosthetic replacement of the ankle joint is considered to be a modern alternative of the well-tried fusions of the joint. We try to explain indications and limits of alloarthroplasty in comparison to arthrodesis. ⋯ Results of three-component endoprostheses in the literature and our own experiences with implants of both generations especially regarding the time of survival will be discussed. Basing on the actual knowledge, we try to deduce a prognosis of the future way of ankle replacement.
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Review Comparative Study
[Proximal and distal ruptures of the biceps brachii tendon].
Proximal ruptures. Ruptures of the long head of the M. biceps humeri are commonly caused by degenerative changes within the tendon. Non-operative treatment gives good results, the loss of power regarding elbow flexion and supination amounts to only 8-21%. ⋯ If supination strength is to be restored, the tendon has to be fixed anatomically. Preparation of the tuberosity bears the risk of heterotopic ossification or nerve damage. Mini-open techniques, using only a limited anterior approach, may decrease risks.
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Humeral head fractures generally may be treated in a non-operative concept with early physiotherapy when fragment dislocation is minor. Dislocated 2-part fractures (head and shaft fragment) may be treated with closed reduction. If the fracture persists unstable, K-wire, cerclage, intramedullary nailing or plate osteosynthesis are the eligible methods. ⋯ In 4-part fractures prosthetic replacement should be considered. Especially when old patients have severe destruction or luxation of the humeral calotte prosthetic treatment may be indicated. Early functional physiotherapy is important after all types of osteosynthesis or prosthesis.
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There have been substantial changes in the management of multiply injured patients over the last decades. In the 1950s and 60s, perioperative care was limited and the surgical techniques were not well developed. It was therefore discussed that a patient might be "too sick to operate" and the general recommendation was to postpone surgical care of the extremities,until a patient had stabilized. ⋯ For these patients, the concept of initial temporary fixation and secondary conversion to a definitive procedure has recently been advocated, and the term "damage control orthopaedic surgery" was coined. Within recent years, an increased consensus has occurred across the countries and the oceans in regards to the acceptance of the concept of damage control. This manuscript documents the pathogenetic back grounds and the clinical results leading to a change in the management of orthopaedic injuries towards damage control.