Der Unfallchirurg
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Pathological fractures are defined as fractures that occur in patients with weakened bone due to systemic and local diseases. If osteoporosis is excluded, the frequency amounts to 5% of all fractures treated. ⋯ For this, diagnostic and therapeutic algorithms are demonstrated, arranged according to osteopathies, constitution anomalies, myelogenous and inflammatory bone diseases, primary and secondary bone tumors and posttraumatic/postoperative disorders. These algorithms should help the trauma and orthopedic surgeon to select the proper conservative and operative therapy and to use all resection and reconstruction possibilities, such as osteosynthesis, alloarthroplasty and bone transplantation.
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Fractures and dislocations of the elbow are some of the most common injuries in childhood and adolescence. The majority occur in sport and play activities, e.g., a fall from gymnastics apparatus or a bike, or from popular sports items, such as skateboards or in-line skates. The injuries can be divided into pure dislocations of the joint and fractures of the distal humerus, proximal radius and ulna, or combinations of both. ⋯ Corrective measures are performed only in selected cases and after the growth plates are closed. Our own treatment regime is demonstrated using exemplary clinical cases of the different injuries and the results of a long-term follow-up study on sports injuries of the elbow in children. Errors in diagnosis and therapy, as well as possible complications, are pointed out.
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Owing to advances in adjuvant therapy, the outlook for patients with primary malignant bone tumors has improved dramatically in recent decades. This applies both to improved survival and to increased limb salvage rates. ⋯ The use of soft tissue procedures such as flaps and the use of modular implant systems has reduced the complication rates of limb salvage procedures. In the future we hope to further improve prognosis and quality of life for such patients by the application of risk-adapted strategies for chemotherapy and surgery.
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Sequestrectomy, fragment fixation, wound treatment and bone grafting are the old principles of infected non union surgery. Today these principles are the frame, which contents a more aggressive treatment. Sequestrectomy is a radical excision of the complete infected bone-soft-tissue-scar, the resulting defects are covered by one of the various techniques (skin-traction, flap surgery, bone shifting, etc.). ⋯ Previous limb shortening to close bone defects, with a lengthening later in a "healthy" region, is also possible. Local antibiotic wound treatment cases a significant reduction of the contamination rate, improved dressing techniques support wound healing free of infection. This therapeutic techniques are comparable to open fracture treatment, where by similar surgery a very low infection rate can be achieved.