Der Unfallchirurg
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Because of the complex fracture morphology and vulnerable soft tissue coverage, fractures of the tibial pilon are difficult to treat. Complications are more common than in bi- or trimalleolar fractures. The surgeon has to know about the special risks of these injuries to avoid complications. ⋯ In late complications such as bony necrosis with or without deviation, non-union and osteoarthrosis of the ankle joint give the surgeon more time for planning the therapy. Intensive monitoring until bone healing is necessary in tibial pilon fractures to detect complications early and start the therapy immediately. This kind of therapy results in the best outcome for these patients.
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Injuries to the upper cervical spine represent a diagnostic and therapeutic challenge to the treating surgeon due to the complex anatomical relationships and biomechanical features. In this further education article the diagnostic principles, established classifications and therapeutic recommendations as well as injury-specific characteristics of bony and ligamentous injuries to the upper cervical spine (C0-C2) are presented.
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Giant cell reparative granuloma (GCRG) is benign, non-tumorous granulation tissue. It mainly arises in the jaw bone and occasionally in the hand and foot. ⋯ We present a case report of a 16-year-old boy with a GCRG of the fifth metacarpal bone and the diagnostic difficulties. To treat the patient, we performed a wide resection with the interposition of a corticocancellous bone graft and plate osteosynthesis. 24 months postoperatively the patient shows no signs of recurrence and has good hand function.
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Intraarticular fractures of the distal tibia (pilon fractures) are rare injuries and today they occur mostly in traffic accidents and falls from a great height. There are simple fractures in the context of low-energy traumas, as well as complex comminuted fractures in high-energy traumas. ⋯ The systems used to classify the displaced distal pilon fractures are supposed to ensure the three-dimensional assessment of the fracture and provide high inter- and intra-observer agreement. In addition to the classification of Rüedi and Allgöwer, the classification of pilon fractures has been carried out using the AO classification.
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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.