Der Unfallchirurg
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Pilon fractures are mainly severe and prognostically serious injuries with a high rate of relevant soft tissue involvement. The adequate decision making and choice of treatment in the early phase of trauma are of paramount importance for the final outcome. This essentially encompasses the management of the soft tissue damage, the surgical planning and the differentiated selection of procedures. ⋯ Knowledge of the multiple procedural variations for pilon fracture treatment creates the basis to optimize the treatment modalities and to take into account individual parameters of the fracture.
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Proximal femoral fractures are one of the most frequently occurring injuries among elderly people. High rates of inpatient treatment indicate the importance of optimized clinical care. ⋯ Analyzing the data of a trauma registry enables critical reflection upon the clinical outcome of interdisciplinary treatment procedures. The low rate of mortality may be a result of the geriatric co-treatment, starting right from admission. It remains unclear whether the influence of preoperative interdisciplinary treatment outweighs the effect of a timely surgical procedure.
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Under optimal conditions, fractures of the tibial pilon can be definitively managed operatively within 6 h after the trauma. Under suboptimal conditions, preoperative antiphlogistic treatment, possibly after approximate correction and external fixation of the alignment, is a reasonable option. Osteosynthesis implies reconstruction of good joint congruency in anatomical orientation. The soft tissue coverage of the distal lower leg is relatively poorly constructed and there is a high risk of devascularization, necrosis and ensuing infection. ⋯ Open reduction and stabilization of pilon fractures enables rapid restoration of joint mobility. After having analyzed the fracture and setting the priorities, the treatment strategy should include a well-thought out selection of possible accesses.
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Carpal tunnel syndrome is among the most frequently diagnosed forms of peripheral nerve compression. Carpal tunnel syndrome due to carpal collapse that had progressed over decades, with a palmarly dislocated lunate, is rare. ⋯ Therefore, precise and complete history-taking is mandatory. Conclusions on further diagnostics that can be drawn from the latter must be consistently implemented to enable adequate therapy.