Der Unfallchirurg
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To what extent does the scientific literature have an impact on current clinical practice guidelines (CPGs) in trauma surgery? ⋯ Information flow between clinical research and CPG development remains difficult. Thoroughly performed literature searches have an important role in CPG development.
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Review Case Reports
[Bilateral atraumatic epiphysiolysis of the head of the tibia].
We report above a 14-year old boy, who suffered from a bilateral epiphyseal fracture type Salter/Harris II of the proximal tibia within four weeks without having an adequate trauma. Accompanying injuries were not found. ⋯ On both sides we achieved a correct axis and length in a uncomplicated healing with free joint movement. On the base of the result of our treatment we show a literature review of this rare form of epiphysiolysis.
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Results after total ankle arthroplasty in the 1970s and 1980s were poor. The outcomes of these surgeries deteriorated rather dramatically with time. Causes of failure were multifactorial, but the two main reasons for failure were constrained designs and cement fixation. ⋯ Because of the associated pain and functional limitations that can follow ankle fusion, efforts to develop a workable total ankle replacement continue. At present, the long-term results of new designs are unknown. Today, total ankle arthroplasty should be limited to centers where patient volume and infrastructure allows critical review and prospective clinical trials to determine the factors leading to successful and unsuccessful outcomes.
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Non-operative treatment with immobilization or isometric traction has been abandoned as treatment for fractures of the distal femur at the end of the 1960ies. The technique of open reduction and internal fixation with a condylar plate as suggested by the AO has been the golden standard since the 1970ies. However, anatomic reconstruction of the condylar region with interfragmentary screw fixation and axial realignment of the femur shaft with a plate are challenging procedures especially in the presence of severely compromised soft tissues and put periosteal blood supply at risk. ⋯ The era of retrograde femoral nailing began with the systematic approach through the intercondylar notch by Green. This paper reviews the biomechanical properties, indication, technique as well as potential hazards and pitfalls of fracture management with the AO "distal femoral nail" (DFN). With appropriate application this technique is suitable for all fractures of the distal third of the femoral shaft including highly instable bicondylar fractures without damage to the soft tissues and the knee joint.