Der Unfallchirurg
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Nonoperative management of forearm fractures in children has a good outcome in over 90% of all cases. In our own series (n = 102) there were only six children (6.1%) with significant limitation (> 25 degrees) of forearm rotation. In these cases two out of four (50%) were located in the proximal third but only two out of 68 in the distal third. ⋯ At final follow-up all had a free ROM and a maximal axial malalignment of less than 5 degrees. In the region of the distal forearm K-wires are useful. Plates play a dominant role for corrections and nonunions; external skeletal stabilization is indicated for temporary fixation in compound fractures.
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Review
[Fractures of the thoracolumbar spine. Late results of dorsal instrumentation and its consequences].
Between January 1989 and July 1992, 76 patients with thoracolumbar fractures were operatively treated at the Department of Trauma Surgery, Hannover Medical School. After a mean of more than 3 years, 56 of 62 patients (90%) still alive who had their implants removed were examined. According to the ASIF classification 33 patients sustained type A fractures, 13 type B and 10 type C. ⋯ No correlation could be found between ASIF classification and radiographic outcome. However, the preoperative wedge angle of the vertebral body correlated significantly with the postoperative loss of reduction. Due to disappointing results after dorsal stabilization with transpedicular cancellous bone grafting we recommend a combined procedure with dorsal stabilization and ventral fusion in cases of complete or incomplete burst injury of the vertebral body.
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The classification of tibial plateau fractures is based on morphological criteria according to AO/ASIF and Schatzker or on functional criteria according to Moore. A total of 81 acute tibial plateau fractures were operated on over a 6-year period. The patient data and the operative procedure are given (not including late results). ⋯ Most important are the soft tissue balance, the timing of surgery, choice of longitudinal incisions directly above the lesion, and a stabilization procedure which maintains blood flow and coverage of the fracture. The operative procedures are described including tibial plateau fractures in children and the management of complications. In special situations a conservative treatment is still useful.